Background There is increasing recognition that dialysis may not offer significant survival advantage or improvement of symptoms, in older patients with high co-morbidity (Hussain, Mooney & Russon, 2013; Chandna, Da Silva-Gane, Marshall et al., 2011; Davidson & Sheerin, 2013; Verberne, Geers, Jellema et al., 2016; Foote, Kotwal, Gallagher et al., 2016). Despite this the number of people over the age of 75 starting dialysis in the UK continues to increase (UK Renal Registry, 2017). Several studies have raised concern that patients are not fully informed about conservative management, or the risks and burdens associated with dialysis, (Brennan, Stewart, Burgess et al., 2017; Davidson, 2010) and around 60% of patients regret their decision to commence dialysis (Davidson, 2010; Muthalagappan, Johansson, Kong et al., 2013), many reporting it was the wish of their physician or family. Locally, patients with renal failure are invited to a patient/carer education session providing detailed information about the different types of dialysis on offer, and individual sessions to revisit options and introduce conservative management. The group session lacked detail on conservative management and the renal supportive service provided by the local hospice.
Aim To improve the decision-making process ensuring patients fully understand all available options, reducing inappropriate commencement of dialysis and patient regret.
Method The author met with the renal nurse manager who provides dialysis modality education in the local area, and offered to deliver information on conservative management and the service provided by the local hospice.
Results To date there have been three collaborative education sessions, providing information to 17 patients and carers. Evaluation of these sessions are consistently positive. Comments include; ‘informative, brilliant, clear explanation of options, we did not know there were so many options, thank you for the information and help’. At the latest session attended by two patients over the age of 75 with multiple co-morbidities and their carers, both patients chose conservative management over dialysis.
Conclusion The success of this project demonstrated that inter-organisational collaboration between the hospice renal service and the hospital renal service enhanced the delivery of information, promoting fully informed patient-centred decision making.
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