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Title: Advance care planning in chronic kidney disease: a survey of current practice in Australia
Austin Authors: Luckett, Tim;Spencer, Lucy;Morton, Rachael L;Pollock, Carol A;Lam, Lawrence;Silvester, William;Sellars, Marcus ;Detering, Karen M ;Butow, Phyllis N;Tong, Allison;Clayton, Josephine M
Affiliation: Improving Palliative Care through Clinical Trials (ImPaCCT) New South Wales, New South Wales, Australia
Faculty of Health, University of Technology Sydney (UTS), Sydney, New South Wales, Australia
Department of Renal Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
Respecting Patient Choices, Austin Health, Melbourne, Victoria, Australia
School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
HammondCare Palliative & Supportive Care Service, Greenwich Hospital, Sydney, New South Wales
Issue Date: Feb-2017 2017-01-08
Publication information: Nephrology 2017; 22(2): 139-149
Abstract: AIM: Advance care planning (ACP) in nephrology is widely advocated but not always implemented. The aims of this study were to describe current ACP practice and identify barriers/facilitators and perceived need for health professional education and chronic kidney disease (CKD)-specific approaches. METHODS: An anonymous cross-sectional survey was administered online. Nephrology health professionals in Australia and New Zealand were recruited via professional societies, email lists and nephrology conferences. Multiple regression explored the influence of respondents' attributes on extent of involvement in ACP and willingness to engage in future. RESULTS: A total of 375 respondents included nephrologists (23%), nurses (65%), social workers (4%) and others (8%) with 54% indicated that ACP at their workplace was performed ad hoc and 61% poorly. Perceived barriers included patient/family discomfort (84%), difficulty engaging families (83%), lack of clinician expertise (83%) and time (82%), health professional discomfort (72%), cultural/language barriers (65%), lack of private space (61%) and lack of formal policy/procedures (60%). Respondents overwhelmingly endorsed the need for more dialysis-specific ACP programs (96%) and education (95%). Whilst 85% thought ACP would be optimally performed by specially trained staff, comments emphasized that all clinicians should have a working proficiency. Respondents who were more willing to engage in future ACP tended to be non-physicians (odds ratio (OR) 4.96, 95% confidence intervals (CI) 1.74-14.07) and reported a greater need for CKD-specific ACP materials (OR 10.88, 95% CI 2.38-49.79). CONCLUSION: Advance care planning in nephrology needs support through education and CKD-specific resources. Endorsement by nephrologists is important. A multidisciplinary approach with a gradient of ACP expertise is also recommended.
DOI: 10.1111/nep.12743
PubMed URL:
Type: Journal Article
Subjects: Advance care planning
Chronic kidney disease
Conservative care
Current practice
Health professional view
Appears in Collections:Journal articles

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