Background It is well recognised that people with advanced kidney disease should have their supportive care needs assessed and have access to palliative care (NSF Renal Services 2005). Despite this, referrals to palliative care services remain low – our hospice received three referrals for patients with End Stage Renal Failure (ESRF) 2014/15 (<1% of all referrals). The number of patients with ESRF is increasing (due to ageing population and associated comorbidities), hence there is increasing unmet need. In order to increase the number of renal patients having access to palliative care, we set up an innovative renal partnership.
Increase number of patients with ESRF having supportive needs assessed.
Increase access to palliative care services for ESRF patients.
Provide opportunity for Advance Care Planning.
Method Following discussion with hospital and regional renal teams and our palliative care team, a new post ‘Advanced Renal Disease Palliative Care Nurse’ was created. Funded by the hospice but working across all settings – new pathways and referral criteria were agreed. The nurse undertakes a parallel hospital clinic with the renal consultant and takes referrals from the renal nurse specialists. Patients are offered clinics at the hospital, hospice or home, including opportunity to discuss Advance Care Plans.
Results In the first three months of the service there have been 15 referrals (compared with three the previous 12 months). Average age 76 years, 76% male. Two thirds have completed advance care planning whilst the range of referrals to other palliative care services demonstrates the unmet need of this group of patients (three referrals to physio, three to Day Hospice, three to Community Companions and one to the carer support group).
Conclusion Early results show this model of care is effective – achieving a 19 fold increase in patients having access to palliative care. Further results including outcome measures available at Conference.
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