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Poster
3a) Advance care planning with focus on specific diseases
P-52 Delivering advance care planning in chronic kidney disease (CKD): The perspectives of healthcare providers
  1. Marcus Sellars1,2,
  2. A Tong3,4,
  3. William Silvester1,
  4. Carol Pollock2,5,
  5. Tim Luckett6,7,8,
  6. Rachael L Morton4,
  7. KM Detering1,
  8. Lucy Spencer8 and
  9. Josephine M Clayton2,9
  1. 1Respecting Patient Choices, Austin Health, Victoria, Australia
  2. 2Sydney Medical School, University of Sydney, Sydney, Australia
  3. 3Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, Australia
  4. 4School of Public Health, University of Sydney, Sydney, Australia
  5. 5Department of Renal Medicine, Royal North Shore Hospital, Sydney, Australia
  6. 6Improving Palliative Care Through Clinical Trials, New South Wales, Australia
  7. 7Faculty of Health, University of Technology Sydney, Australia
  8. 8South Western Clinical School, University of New South Wales, Sydney, Australia
  9. 9HammondCare Palliative & Supportive Care Service, Greenwich Hospital, Sydney, Australia

Abstract

Background Although recent clinical practice guidelines have highlighted the importance of advance care planning (ACP) for improving end-of-life care for people with chronic kidney disease (CKD), ACP can be complex and emotionally challenging for patients and providers, which may explain the limited uptake of ACP in renal settings.

Aim To describe the perspectives and experiences of healthcare providers who have facilitated ACP for patients with CKD.

Methods Face-to-face and telephone semi-structured interviews were conducted with nephrologists, nephrology nurses, nephrology social workers and dedicated nephrology ACP facilitators purposively sampled from all Australian states/territories. Data were analysed using grounded theory and thematic analysis.

Results Based on 10 interviews conducted to date, we identified four themes: embedding ACP into practice (availability of resources and materials, gaining competence, and perceptible value of ACP in practice); patient-focused ACP (understanding individual contexts, readiness and preparedness to discuss ACP and flexibility of patient decisions over time); comfort with ACP (patient’s stage of illness and age, perceived appropriateness and previous exposure to ACP); and enacting patient wishes (availability of ACP documents, clarity of documented wishes and competing agendas).

Discussion Healthcare providers who have participated in ACP for patients with CKD perceive ACP as important for patient care in supporting informed and respected choices. However, ACP can be complex and difficult to integrate in routine practice because of limited support to facilitate this process.

Conclusion Strategies are needed to facilitate the process of integrating ACP in the clinical care of patients with CKD.

https://doi.org/10.1136/bmjspcare-2015-000978.182

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