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. 2017 Apr;20(2):260-273.
doi: 10.1111/hex.12454. Epub 2016 Mar 10.

End-of-life care decisions for haemodialysis patients - 'We only tend to have that discussion with them when they start deteriorating'

Sophia Lazenby  1 , Adrian Edwards  2   3 , Raymond Samuriwo  4   5   6 , Stephen Riley  7 , Mary Ann Murray  8 , Andrew Carson-Stevens  3   9   10
Affiliations

End-of-life care decisions for haemodialysis patients - 'We only tend to have that discussion with them when they start deteriorating'

Sophia Lazenby et al. Health Expect. 2017 Apr.

Abstract

Background: Haemodialysis patients receive very little involvement in their end-of-life care decisions. Issues relating to death and dying are commonly avoided until late in their illness. This study aimed to explore the experiences and perceptions of doctors and nurses in nephrology for involving haemodialysis patients in end-of-life care decisions.

Methods: A semi-structured qualitative interview study with 15 doctors and five nurses and thematic analysis of their accounts was conducted. The setting was a large teaching hospital in Wales, UK.

Results: Prognosis is not routinely discussed with patients, in part due to a difficulty in estimation and the belief that patients do not want or need this information. Advance care planning is rarely carried out, and end-of-life care discussions are seldom initiated prior to patient deterioration. There is variability in end-of-life practices amongst nephrologists; some patients are felt to be withdrawn from dialysis too late. Furthermore, the possibility and implications of withdrawal are not commonly discussed with well patients. Critical barriers hindering better end-of-life care involvement for these patients are outlined.

Conclusions: The study provides insights into the complexity of end-of-life conversations and the barriers to achieving better end-of-life communication practices. The results identify opportunities for improving the lives and deaths of haemodialysis patients.

Keywords: advance care planning; decision making; end of life; haemodialysis; nephrologists; prognosis.

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References

    1. Dixon‐Woods M, Baker R et al Culture and behaviour in the English National Health Service: overview of lessons from a large multimethod study. BMJ Quality & Safety, 2014; 23: 106–115. - PMC - PubMed
    1. Najjar S, Hamdan M, Euwema MC et al The Global Trigger Tool shows that one out of seven patients suffers harm in Palestinian hospitals: challenges for launching a strategic safety plan. International Journal for Quality in Health Care, 2013; 25: 640–647. - PubMed
    1. Hignett S, Jones EL et al Human factors and ergonomics and quality improvement science: integrating approaches for safety in healthcare. BMJ Quality & Safety, 2015. In Press. - PMC - PubMed
    1. Bergman B, Neuhauser D, Provost L. Five main processes in healthcare: a citizen perspective. BMJ Quality & Safety, 2011; 20 (Suppl. 1): i41–i42. - PMC - PubMed
    1. Kwok AC, Semel ME, Lipsitz SR et al The intensity and variation of surgical care at the end of life: a retrospective cohort study. The Lancet, 2011; 378: 1408–1413. - PubMed

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