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Nephrologists’ Reported Preparedness for End-of-Life Decision-Making
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46 yr, six or more patients withdrawn from dialysis in the preceding year, and awareness of the RPA/American Society of Nephrology (ASN) guideline on dialysis decision-making were independently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, 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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Reengineering Dialysis: The Role of Palliative Medicine
Feely, M. A., Swetz, K. M., Zavaleta, K. W., Thorsteinsdottir, B., Albright, R. C., & Williams, A. W. (2016) · Journal of Palliative Medicine · doi:10.1089/jpm.2015.0181 · Cited by 19
“The paucity of baseline goal of care documentation may reflect the ESRD teams’ lack of training or discomfort in approaching these discussions as has been shown in prior studies, 17 with the improved documentation of goals of care reflecting the value added of SPM partnership.”
Shared Decision-Making and Patient Communication in Nephrology Practice
Mandel, E. I., Fox, M., Schell, J. O., & Cohen, R. A. (2024) · Advances in Kidney Disease and Health · doi:10.1053/j.akdh.2023.12.003 · Cited by 19
Methodological considerations for end-of-life research in patients with chronic kidney disease.
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Renal Supportive Care: View from Across the Pond: The United States Perspective
Germain, M. J., & Cohen, L. M. (2007) · Journal of Palliative Medicine · doi:10.1089/jpm.2006.0252 · Cited by 17
A Survey of Canadian Nephrologists Assessing Prognostication in End-Stage Renal Disease
Forzley, B., Chiu, H., Djurdjev, O., Carson, R. C., Hargrove, G. M., Martinusen, D. J., & Karim, M. (2017) · Canadian Journal of Kidney Health and Disease · doi:10.1177/2054358117725294 · Cited by 19
“A response rate of 43% is relatively favorable and comparable to other similar published surveys.(36-40) It is also unreliable to judge the quality of the survey data solely by its response rate.”
ResultMoss, A. H. (2017) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2016.10.371 · Cited by 17
Self-citationPalliative dialysis: Addressing the need for alternative dialysis delivery modes
Tentori, F., Hunt, A., & Nissenson, A. R. (2019) · Seminars in Dialysis · doi:10.1111/sdi.12820 · Cited by 17
Conservative Kidney Management: When, Why, and For Whom?
Li, K. C., & Brown, M. A. (2023) · Seminars in Nephrology · doi:10.1016/j.semnephrol.2023.151395 · Cited by 14
Withholding and Withdrawing Renal Support in Acute Kidney Injury
Granado, R. C., & Mehta, R. L. (2011) · Seminars in Dialysis · doi:10.1111/j.1525-139x.2011.00832.x · Cited by 14
“study were aware of the existence of that guideline and from those who were aware only 84% use it to help clinical decision making (2).”
BackgroundRabetoy, C. P., & Bair, B. C. (2007) · PubMed · Cited by 14
A Pilot Study of the Serious Illness Conversation Guide in a Dialysis Clinic
Mandel, E. I., Maloney, F. L., Pertsch, N. J., Gass, J. D., Sanders, J. J., Bernacki, R., & Block, S. D. (2023) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/10499091221147303 · Cited by 13
Butler, C. R., Schwarze, M. L., Katz, R., Hailpern, S. M., Kreuter, W., Hall, Y. N., Montez‐Rath, M. E., & O’Hare, A. M. (2019) · Journal of the American Society of Nephrology · doi:10.1681/asn.2018101002 · Cited by 12
A Randomized Trial of Expanding Choice Sets to Motivate Advance Directive Completion
Courtright, K. R., Madden, V. L., Gabler, N. B., Cooney, E. L., Kim, J. S., Herbst, N. P., Burgoon, L., Whealdon, J., Dember, L. M., & Halpern, S. D. (2016) · Medical Decision Making · doi:10.1177/0272989x16663709 · Cited by 14
“We sought to test a less resource-intensive, more scalable approach due to well-recognized limitations on physicians’ time and understanding.(56,57) However, at least in this case, the virtue of scalability may have been offset by lower efficacy.”
BackgroundBetter Informing Older Patients With Kidney Failure in an Era of Patient-Centered Care
Ladin, K., & Weiner, D. E. (2015) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2015.01.003 · Cited by 12
Thorsteinsdottir, B., Hickson, L. J., Giblon, R. E., Pajouhi, A., Connell, N., Branda, M. E., Vasdev, A. K., McCoy, R. G., Zand, L., Tangri, N., et al. (2021) · PLoS ONE · doi:10.1371/journal.pone.0244081 · Cited by 13
Disentangling Consumer and Provider Predictors of Advance Care Planning
Baughman, K. R., Ludwick, R. E., Merolla, D. M., Palmisano, B. R., Hazelett, S. E., Allen, K. R., & Sanders, M. (2012) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909112464692 · Cited by 11
“The age and experience of the physician can also impact physician decisions to initiate ACP discussions.(14) Nursing and social work are 2 disciplines with the communication skills to have conversations with patients about ACP.”
BackgroundProfessional Judgments About Advance Care Planning With Community-Dwelling Consumers
Baughman, K. R., Ludwick, R. E., Merolla, D. M., Palmisano, B. R., Hazelett, S. E., Winchell, J., & Hewit, M. (2011) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2011.03.023 · Cited by 11
A Psychiatric Perspective of Dialysis Discontinuation
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Clinical excellence in nephrology: Examples from the published literature
Geetha, D., Lee, S. K., Srivastava, A. J., Kraus, E. S., & Wright, S. M. (2015) · BMC Nephrology · doi:10.1186/s12882-015-0134-1 · Cited by 11
“However, merely 61 % of nephrologists belonging to RPA were even aware of the RPA/ASN guidelines, and only 51 % of these doctors reported using them [20].”
BackgroundThe Overuse, Underuse, and Misuse of Dialysis in ESKD Patients with Dementia
MacPhail, A., Ibrahim, J., Fetherstonhaugh, D., & Levidiotis, V. (2015) · Seminars in Dialysis · doi:10.1111/sdi.12392 · Cited by 11
“Clinicians are not legally required to provide treatment that is either futile or unduly burdensome (11).”
BackgroundA Novel Interprofessional Palliative Care and Geriatrics Curriculum for Nephrology Teams
Fulton, A. T., Richman, K., Azar, M., Sanzen, K., Devine, J., Ferrone, C., Tanzer, J. R., & Lally, K. M. (2020) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909120915462 · Cited by 10
“Older patients with CKD are inevitably faced with issues around death and dying, yet the majority of nephrologists do not feel adequately prepared to guide end-of-life decisions.(7) Of 204 renal fellows surveyed across 104 different American fellowship programs, 99% believed that physicians have a responsibility to he…”
Background
Metadata
- Authors
- Davison, S. N., Jhangri, G. S., Holley, J. L., & Moss, A. H.
- Affiliations
- West Virginia University (US)
- Corresponding author
- Davison, Sara N.
- Venue
- Clinical Journal of the American Society of Nephrology
- Published
- 2006-11
- Volume
- 1
- Issue
- 6
- Pages
- 1256-1262
- ISSN
- 1555-9041 (ISSN-L)
- 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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