Nephrol Dial Transplant (2003) 18: 1345-1352
© 2003 European Renal Association-European Dialysis and Transplant Association
Symptom burden, quality of life, advance care planning and the potential value of palliative care in severely ill haemodialysis patients
1 Department of Medicine, Renal-Electrolyte Division, 2 Department of Medicine, Section of Palliative Care and Medical Ethics, 3 Department of Critical Care Medicine, 6 Department of Medicine, Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, Institute for Performance Improvement, University of Pittsburgh School of Medicine, 4 Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA and 5 Department of Psychiatry, Baystate Medical Center, Tufts University School of Medicine. Springfield, MA, USA
Background. There has been little research on the potential value of palliative care for dialysis patients. In this pilot study, we sought (i) to identify symptom burden, health-related quality of life (HRQoL) and advance directives in extremely ill haemodialysis patients to determine their suitability for palliative care and (ii) to determine the acceptability of palliative care to patients and nephrologists.
Methods. Nineteen haemodialysis patients with modified Charlson co-morbidity scores of ≥8 were recruited. Each completed surveys to assess symptom burden, HRQoL and prior advance care planning. Palliative care specialists then visited patients twice and generated recommendations. Patients again completed the surveys, and dialysis charts were reviewed to assess nephrologists' (i) compliance with recommendations and (ii) documentation of symptoms reported by patients on the symptom assessment survey. Patients and nephrologists then completed surveys assessing their satisfaction with palliative care.
Results. Patients reported 10.5 symptoms, 40% of which were noted by nephrologists in patients' charts. HRQoL was significantly impaired. Thirty-two percent of patients had living wills. No differences were observed in symptoms, HRQoL or number of patients establishing advance directives as a result of the intervention. Sixty-eight percent of patients and 76% of nephrologists rated the intervention worthwhile.
Conclusions. Extremely ill dialysis patients have marked symptom burden, considerably impaired HRQoL and frequently lack advance directives, making them appropriate candidates for palliative care. Patients and nephrologists perceive palliative care favourably despite its lack of effect in this study. A more sustained palliative care intervention with a larger sample size should be attempted to determine its effect on the care of this population.
Keywords: advance care planning; health-related quality of life; palliative care; symptom burden
Correspondence and offprint requests to: Steven D. Weisbord, MD, Renal-Electrolyte Division, University of Pittsburgh Medical Center, A919 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA. Email: weisbordsd{at}msx.upmc.edu
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  K. Abdel-Kader, M. L. Unruh, and S. D. Weisbord Symptom Burden, Depression, and Quality of Life in Chronic and End-Stage Kidney Disease Clin. J. Am. Soc. Nephrol., June 1, 2009; 4(6): 1057 - 1064. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Yong, A. Kwok, D. Wong, M. Suen, W. Chen, and D. Tse Symptom burden and quality of life in end-stage renal disease: a study of 179 patients on dialysis and palliative care Palliative Medicine, March 1, 2009; 23(2): 111 - 119. [Abstract] [PDF]
|
|
|
|
|
|
D. Janssen, M. Spruit, E. Wouters, and J. Schols Daily symptom burden in end-stage chronic organ failure: a systematic review Palliative Medicine, December 1, 2008; 22(8): 938 - 948. [Abstract] [PDF]
|
|
|
|
 |
|
 V. De Biase, O. Tobaldini, C. Boaretti, C. Abaterusso, N. Pertica, C. Loschiavo, G. Trabucco, A. Lupo, and G. Gambaro Prolonged conservative treatment for frail elderly patients with end-stage renal disease: the Verona experience Nephrol. Dial. Transplant., April 1, 2008; 23(4): 1313 - 1317. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. A. Lorenz, J. Lynn, S. M. Dy, L. R. Shugarman, A. Wilkinson, R. A. Mularski, S. C. Morton, R. G. Hughes, L. K. Hilton, M. Maglione, et al. Evidence for Improving Palliative Care at the End of Life: A Systematic Review Ann Intern Med, January 15, 2008; 148(2): 147 - 159. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. D. Weisbord, L. F. Fried, M. K. Mor, A. L. Resnick, M. L. Unruh, P. M. Palevsky, D. J. Levenson, S. H. Cooksey, M. J. Fine, P. L. Kimmel, et al. Renal Provider Recognition of Symptoms in Patients on Maintenance Hemodialysis Clin. J. Am. Soc. Nephrol., September 1, 2007; 2(5): 960 - 967. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. E. M. Murtagh, J. E. Marsh, P. Donohoe, N. J. Ekbal, N. S. Sheerin, and F. E. Harris Dialysis or not? A comparative survival study of patients over 75 years with chronic kidney disease stage 5 Nephrol. Dial. Transplant., July 1, 2007; 22(7): 1955 - 1962. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T Saini, F E. Murtagh, P J Dupont, P M McKinnon, P Hatfield, and Y Saunders Comparative pilot study of symptoms and quality of life in cancer patients and patients with end stage renal disease Palliative Medicine, September 1, 2006; 20(6): 631 - 636. [Abstract] [PDF]
|
|
|
|
|
|
S. Gunda, M. Thomas, and S. Smith National survey of palliative care in end-stage renal disease in the UK Nephrol. Dial. Transplant., February 1, 2005; 20(2): 392 - 395. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. B. Levy, E. J. Chambers, and E. A. Brown Supportive care for the renal patient Nephrol. Dial. Transplant., June 1, 2004; 19(6): 1357 - 1360. [Full Text] [PDF]
|
|
|
|
|
|
A. K. Ghosh Assessment of severity of illness in end-stage renal disease patients: need for multi-disciplinary effort Nephrol. Dial. Transplant., December 1, 2003; 18(12): 2688 - 2688. [Full Text] [PDF]
|
|