Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Aug;10(4):437-442.
doi: 10.1093/ckj/sfx005. Epub 2017 Mar 1.

An end-of-life practice survey among clinical nephrologists associated with a single nephrology fellowship training program

Kevin A Ceckowski  1 , Dustin J Little  1 , Joseph R Merighi  2 , Teri Browne  3 , Christina M Yuan  1
Affiliations

An end-of-life practice survey among clinical nephrologists associated with a single nephrology fellowship training program

Kevin A Ceckowski et al. Clin Kidney J. 2017 Aug.

Abstract

Background: Our nephrology fellowship requires specific training in recognition and referral of end-stage renal disease patients likely to benefit from palliative and hospice care.

Methods: To identify end-of-life (EOL) referral barriers that require greater training emphasis, we performed a cross-sectional, 17-item anonymous online survey (August-October 2015) of 93 nephrologists associated with the program since 1987.

Results: There was a 61% response rate (57/93 surveys). Ninety-five percent practiced clinical nephrology (54/57). Of these, 51 completed the survey (55% completion rate), and their responses were analyzed. Sixty-four percent were in practice >10 years; 65% resided in the Southern USA. Ninety-two percent felt comfortable discussing EOL care, with no significant difference between those with ≤10 versus >10 years of practice experience (P = 0.28). Thirty-one percent reported referring patients to EOL care 'somewhat' or 'much less often' than indicated. The most frequent referral barriers were: time-consuming nature of EOL discussions (27%); difficulty in accurately determining prognosis for <6-month survival (35%); patient (63%) and family (71%) unwillingness; and patient (69%) and family (73%) misconceptions. Fifty-seven percent would refer more patients if dialysis or ultrafiltration could be performed in hospice. Some reported that local palliative care resources (12%) and hospice resources (6%) were insufficient.

Conclusions: The clinical nephrologists surveyed were comfortable with EOL care discussion and referral. Patient, family, prognostic and system barriers exist, and many reported lower than indicated referral rates. Additional efforts, including, but not limited to, EOL training during fellowship, are needed to overcome familial and structural barriers to facilitate nephrologist referral for EOL care.

Keywords: dialysis; end-of-life; hospice; nephrology; palliative care.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

References

    1. Bao Y, Dalrymple L, Chertow GM. et al. Frailty, dialysis initiation, and mortality in ESRD. Arch Intern Med 2012; 172: 1071–1077 - PMC - PubMed
    1. Johansen KL, Chertow GM, Jin C. et al. Significance of frailty among dialysis patients. J Am Soc Nephrol 2007; 18: 2960–2967 - PubMed
    1. Schmidt RJ. Informing our elders about dialysis: is an age-attuned approach warranted? Clin J Am Soc Nephrol 2012; 7: 185–191 - PubMed
    1. Graveran CT. Hospice, dialysis, and health care reform. Nephrol News Issues 2015; 29: 46–57 - PubMed
    1. Verberne WR, Geers ABMT, Jellema WT. et al. Comparative survival among older adults with advanced kidney disease managed conservatively versus with dialysis. Clin J Am Soc Nephrol 2016; 17: 633–640 - PMC - PubMed

LinkOut - more resources