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Cited by 62Palliative Care and End-of-Life IssuesDialysis and Renal Disease ManagementPalliative and Oncologic Care

Nephrologists’ Changing Practices in Reported End-of-Life Decision-Making

Holley, Jean L., Davison, Sara N., Moss, Alvin H.·2007·Clinical Journal of the American Society of Nephrology
DOI 10.2215/cjn.03080906
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Abstract

Because the dialysis patient population is increasingly composed of older patients with high symptom burden, shortened life expectancy, and multiple comorbid conditions, nephrologists often engage in end-of-life decision-making with their patients. In the 1990s, reported practices of nephrologists' end-of-life decision-making showed much variability. In part as a reaction to that variability, the Renal Physicians Association (RPA) and the American Society of Nephrology (ASN) developed a clinical practice guideline on end-of-life decision-making. To determine whether nephrologists' attitudes and reported practices had changed over time, survey responses from 296 nephrologists completing an online survey in 2005 were compared with 318 nephrologists who completed a similar mailed survey in 1990. In 2005, less variability was noted in reported practices to withhold dialysis from a permanently unconscious patient (90% would withhold in 2005 versus 83% who would withhold in 1990, P < 0.001) and to stop dialysis in a severely demented patient (53% in 2005 would stop versus 39% in 1990, P < 0.00001). In 2005, significantly more dialysis units were reported to have written policies on cardiopulmonary resuscitation (86% in 2005 versus 31% in 1990, P < 0.0001) and withdrawal of dialysis (30% in 2005 versus 15% in 1990, P < 0.0002); nephrologists were also more likely to honor a dialysis patient's do-not-resuscitate order (83% in 2005 versus 66%, P < 0.0002) and to consider consulting a Network ethics committee (52% in 2005 versus 39%, P < 0.001). Nephrologists' reported practices in end-of-life care have changed significantly over the 15 years separating the two surveys, suggesting that the development of the clinical practice guideline was worthwhile.

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Authors
Holley, J. L., Davison, S. N., & Moss, A. H.
Affiliations
West Virginia University (US)
Corresponding author
Holley, Jean L.
ORCID
Venue
Clinical Journal of the American Society of Nephrology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2007-01
Volume
2
Issue
1
Pages
107-111
ISSN
1555-9041 (ISSN-L)
DOI
10.2215/cjn.03080906
OpenAlex
W2150981683
Cited by
62
References
15
Citations by year
2025: 1 · 2024: 1 · 2023: 6 · 2022: 2 · 2020: 1 · 2019: 3 · 2018: 1 · 2017: 1 · 2016: 7 · 2015: 4 · 2014: 3 · 2013: 7 · 2012: 7
FWCI
3.66
Type
journal article
Language
en
Open access
closed
Locations
  • Clinical Journal of the American Society of Nephrology (publishedVersion)
  • PubMed (publishedVersion)
  • DigitalGeorgetown (Georgetown University Library) (submittedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
Keywords
end-of-life decisions, dialysis, do-not-resuscitate orders, dialysis withdrawal, American Society of Nephrology, ethics consultation
MeSH terms
Attitude of Health Personnel, Decision Making, Renal Dialysis, Humans, Kidney Failure, Chronic, Health Knowledge, Attitudes, Practice, Middle Aged, Nephrology, Professional Practice, Terminal Care, Resuscitation Orders, Ethics Committees, Health Care Surveys, Guideline Adherence

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