Advance care planning for patients with end-stage kidney disease on dialysis: narrative review of the current evidence, and future considerations

Abstract

Patients with end-stage kidney disease (ESKD) have a high symptom-burden and high rates of morbidity and mortality. Despite this, evidence has shown that this patient group does not have timely discussions to plan for deterioration and death, and at the end of life there are unmet palliative care needs. Advance care planning is a process that can help patients share their personal values and preferences for their future care and prepare for declining health. Earlier, more integrated and holistic advance care planning has the potential to improve access to care services, communication, and preparedness for future decision-making and changing circumstances. However, there are many barriers to successful implementation of advance care planning in this population. In this narrative review we discuss the current evidence for advance care planning in patients on dialysis, the data around the barriers to advance care planning implementation, and interventions that have been trialled. The review explores whether the concepts and approaches to advance care planning in this population need to be updated to encompass current and future care. It suggests that a shift from a problem-orientated approach to a goal-orientated approach may lead to better engagement, with more patient-centred and satisfying outcomes.

Keywords: Advance care planning; Dialysis; End of life; End-stage kidney disease; Palliative.

Fig. 1

A figure demonstrating the over-arching concept of supportive care and the balance of restorative, palliative and end-of-life care at different stages of disease. Advance care planning discussions should ideally be started early and be an iterative process. Adapted from [23, 24]