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Cited by 154Palliative Care and End-of-Life IssuesPalliative and Oncologic CareDialysis and Renal Disease Management

Nephrologists’ Reported Preparedness for End-of-Life Decision-Making

Davison, Sara N., Jhangri, Gian S., Holley, Jean L., Moss, Alvin H.·2006·Clinical Journal of the American Society of Nephrology
DOI 10.2215/cjn.02040606
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Abstract

Nephrologists commonly engage in end-of-life decision-making with patients with ESRD and their families. The purpose of this study was to determine the perceived preparedness of nephrologists to make end-of-life decisions and to determine factors that are associated with the highest level of perceived preparedness. The nephrologist members of the Renal Physicians Association (RPA) and the Canadian Society of Nephrology were invited to participate in an online survey of their end-of-life decision-making practices. A total of 39% of 360 respondents perceived themselves as very well prepared to make end-of-life decisions. Age >46 yr, six or more patients withdrawn from dialysis in the preceding year, and awareness of the RPA/American Society of Nephrology (ASN) guideline on dialysis decision-making were independently associated with the highest level of self-reported preparedness. Nephrologists who reported being very well prepared were more likely to use time-limited trials of dialysis and stop dialysis of a patient with permanent and severe dementia. Compared with Americans, Canadian nephrologists reported being equally prepared to make end-of-life decisions, stopped dialysis of a higher number of patients, referred fewer to hospice, and were more likely to stop dialysis of a patient with severe dementia. Nephrologists who have been in practice longer and are knowledgeable of the RPA/ASN guideline report greater preparedness to make end-of-life decisions and report doing so more often in accordance with guideline recommendations. To improve nephrologists' comfort with end-of-life decision-making, fellowship programs should teach the recommendations in the RPA/ASN guideline and position statement.

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  • ESRD patients spend an average of only 14 days in hospice, compared with 59 days for patients with other diseases, which suggests late referral.

    “ESRD patients spend an average of only 14 days in hospice, in contrast to the average of 59 days for patients with other diseases, suggesting that they are referred late in the dying process [35].”

    From Should there be an expanded role for palliative care in end-stage renal disease? (2010) · cites this paper as [35]

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Authors
Davison, S. N., Jhangri, G. S., Holley, J. L., & Moss, A. H.
Affiliations
West Virginia University (US)
Corresponding author
Davison, Sara N.
ORCID
Venue
Clinical Journal of the American Society of Nephrology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2006-11
Volume
1
Issue
6
Pages
1256-1262
ISSN
1555-9041 (ISSN-L)
DOI
10.2215/cjn.02040606
OpenAlex
W2083351167
Cited by
154
References
14
Citations by year
2026: 1 · 2025: 1 · 2024: 2 · 2023: 6 · 2022: 5 · 2021: 1 · 2020: 7 · 2019: 9 · 2018: 4 · 2017: 8 · 2016: 17 · 2015: 17 · 2014: 7 · 2013: 11 · 2012: 16
FWCI
8.99
Type
journal article
Language
en
Open access
closed
Locations
  • Clinical Journal of the American Society of Nephrology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
Keywords
end-of-life decisions, nephrologists, end-stage renal disease, dialysis withdrawal, physician preparedness, advanced dementia, hospice referral
MeSH terms
Adult, Aged, Canada, Decision Making, Humans, Kidney Failure, Chronic, Middle Aged, Nephrology, Surveys and Questionnaires, Societies, Medical, Terminal Care, United States

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