Background Patients with end stage renal failure on dialysis have a high symptom burden (1) and survival on dialysis can be comparable to some cancers. (2) Increasingly it is recognised that patients with advancing age and comorbidities may benefit from a conservative approach rather than dialysis.(3) Patients with non-malignant disease often receive palliative services late or not at all.(4)
Aims Development of a monthly Renal Palliative MDT meeting alongside a Supportive Care Register (SCR) with the aim to improve renal palliative integration, education and support for patients with End Stage Renal Failure (ESRF), particularly focusing on haemodialysis (HD).
Results Data from 2018/19 collected and analysed. All deaths in patients on haemodialysis were analysed. In 2019 increasing amounts of haemodialysis patients who died had been identified and placed on SCR (48% versus 70%). Numbers of deaths in those not on SCR or discussed at MDT reducing. 69% of patients identified on SCR died in a community setting in 2018, this has increased in 2019 to 75% dying in a community setting.
Conclusion A SCR and monthly MDT improved access by identifying patients earlier. Numbers of deaths in those not on SCR or discussed at MDT reducing each year, suggesting we are missing less of the patients who are likely to die. Some HD deaths will be in chronic patients who we could not predict would die suddenly. The referrals have been appropriate and controlled in number. The majority of patients on SCR and discussed died out of hospital in a community setting. A greater understanding of the population we support and mutual education has resulted in closer working relationships and increased referrals. Further development of a joint Nephrology/Palliative clinic is planned. A focus group to identify patient and carer needs and experiences is planned.
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