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32 Integrated renal palliative care – creating a community of practice
  1. Louise Gilhooley,
  2. Sunita Nair,
  3. Elaine Gibson and
  4. Rebecca Verling
  1. Severn Hospice, Shrewsbury and Telford NHS Trust


Introduction It is increasingly recognised that patients with end stage renal failure can have needs similar to those with advanced cancer. This is particularly relevant in patients who have opted for conservative management or who wish to withdraw from renal replacement therapy (RRT) and in those patients who are deteriorating despite RRT. In Shropshire a renal palliative multidisciplinary team (MDT) has been formed and it is recognised that mutual education is important in delivering a good service to these patients.

Methods Joint workshops were held to identify learning needs and a two day programme was then designed and delivered in June/July 2017. Day one covered aspects of mortality/morbidity of RRT in an ageing population, conservative care, psychological adaptations and symptom management. Day two delivered communication skills training specific to renal scenarios, using simulated patients.

Results The course was well attended and positively evaluated. Overall delegates reported an improved confidence in approaching end of life issues in renal patients and a recognition of the importance and benefit of a collaborative approach, with effective information sharing and ongoing co-education. Recognised especially was the complexity of an ageing and increasing frail population of patients and a recognition of the psychological adaptations over time to renal failure. Evaluations for communication skills training revealed increased confidence in initiating and expanding conversations, especially around advance care planning and resuscitation.

Conclusion A greater understanding of the population we support and mutual education has resulted in closer working relationships within the renal palliative MDT. Dialysis end of life link nurses have planned spin-off educational sessions with frontline dialysis staff. The education programme is to be repeated in 2018 using a similar format. Similar streams of education in heart failure are planned.

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