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Survey on advance care planning of Italian outpatients on chronic haemodialysis
  1. Nicola Panocchia1,
  2. Giuseppe Tonnara2,
  3. Roberta Minacori3,
  4. Dario Sacchini3,
  5. Maurizio Bossola1,
  6. Luigi Tazza1,
  7. Giovanni Gambaro1 and
  8. Antonio Gioacchino Spagnolo3
  1. 1 Division of Nephrology, Fondazione Policlinico Gemelli Roma, Rome, Italy
  2. 2 Centro Medicina Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
  3. 3 Institutes of Bioethics and Medical Humanities School of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
  1. Correspondence to Dr Nicola Panocchia, Nephrology Division, Fondazione Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy; npanocc{at}


Objectives The clinical practice guidelines published by the Renal Physicians Association (USA) recommend instituting advance care planning (ACP) for patients with end-stage renal disease. Studies on this issue are lacking in Italy. Our aim was to determine the attitudes of patients on ACP in our dialysis centre.

Methods We performed a cross-sectional survey. We recruited patients on maintenance haemodialysis (HD) at Hemodialysis Center of Università Cattolica del Sacro Cuore, from 1 March 2014 to 31 March 2015. The only exclusion criterion was inability to give an informed consent. Patients completed a questionnaire concerning their treatment preferences in three hypothetical disease scenarios: persistent vegetative state, advanced dementia, severe terminal illness; for each patients, we also collected clinical, functional and socioeconomic data.

Results Thirty-four HD outpatients completed the study questionnaire. The majority of respondents (85%) considered information about prognosis, health conditions and treatment options, including withdrawing dialysis, as very important and 94% of respondents considered treatment of uraemic/dialytic symptoms the most important issue. In the health scenarios provided, dialysis was the treatment least withheld. Dependence on instrumental activities of daily living (0.048) and higher Charlson Comorbidity Index scores (p=0.035) were associated with continuing dialysis in at least one scenario.

Conclusions ACP should be tailored to patients’ value, culture and preferences. A significant proportion of patients, however, do not want to be involved in end of life decisions. Frail elderly patients, in particular, are not inclined to interrupt dialysis, despite poor quality of life or a poor prognosis.

  • Advance care planning
  • chronic kidney disease
  • dialysis
  • end of life care
  • ethics.

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  • Contributors Conception and design of study: NP, GT, RM, AGS. Analysis of data: NP, GT. Interpretation of data: NP, RM, MB, AGS. Drafting the article or revising it: NP, GT, RM, DS, GG. Providing intellectual content of critical importance to the work described: NP, RM, DS, MS, LT, GG. Final approval of the version to be published: NP, GT, RM, DS, MB, LT, GG, AGS.

  • Competing interests None declared.

  • Ethics approval The Institutional Review Board of università cattolica del Sacro Cuore Policlinico Gemelli Roma.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with ‘BMJ Publishing Group’. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.