A RECENT study assessed the acceptability of a palliative care (PC) intervention designed for older adults with chronic kidney disease (CKD) and involved nephrologists in the decision-making process.
The study cohort comprised 19 patients, with a mean age of 80, who expressed appreciation for the intervention, valuing the communication skills and whole-person approach taken by PC physicians, which helped them understand prognostic information and make informed decisions. Nephrologists (n=24) also welcomed the support PC provided, particularly for decision-making, conservative kidney management, and symptom control, although some voiced concerns over third-party involvement.
The study’s findings are consistent with the literature indicating that effective PC visits involve excellent communication, holistic care, and shared decision-making. This aligns with earlier studies demonstrating the acceptability of joint nephrology-PC care models and telemedicine-based PC for dialysis patients. However, this intervention focused exclusively on older patients with advanced CKD who were considering kidney therapy options.
Patient and caregiver feedback led to adjustments in the intervention, including additional educational resources and a decision-making video. The study also introduced the “Deciding Not to Decide” option, catering to patients who preferred to defer treatment decisions. This flexible approach aims to support patients’ evolving preferences, acknowledging that their choices might change over time.
Despite the overall positive reception, some nephrologists were uneasy about conservative kidney management considerations, fearing potential disruptions to the doctor-patient relationship due to third-party involvement. Similar concerns are reported among clinicians in other fields, who may view PC as infringing on their professional territory or risking perceptions of abandonment or failure. These issues highlight the need for clear interdisciplinary communication and an understanding of PC’s supportive role.
Katie Wright, EMJ
Reference
Saeed F et al. Palliative care acceptability for older adults with advanced CKD: a qualitative study of patients and nephrologists. Kidney Med. 2024;6(10):100883.
