Closing the Gap on the Palliative Care Needs of Patients with Kidney Disease: Innovations from the Pathways Project (TH306)

Abstract

•Summarize recent research findings on the unmet palliative care needs of patients with advanced chronic kidney disease and end-stage kidney disease.•Present the current state of early adopter dialysis center implementation of primary palliative care for their patients.•Describe three components of the dialysis facility improvement team processes to identify seriously ill patients with advanced CKD and ESKD and provide goal concordant care.•Present outcomes of implementation of communication principles to conduct shared decision-making and advance care planning with patients with advanced CKD and their families.•Describe the extent to which nephrologist/dialysis center medical director buy-in influenced the success of the implementation intervention. Among seriously ill patients, those with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD) arguably receive among the worst end-of-life care. These patients frequently die in the hospital, often after an intensive procedure like cardiopulmonary resuscitation, and with a low referral rate to hospice. There is now a concerted effort in the nephrology and palliative care communities to integrate palliative care into the treatment of these seriously ill patients. The Pathways Project is a national demonstration, funded by the Gordon and Betty Moore Foundation, to develop scalable innovations in kidney supportive care. Fifteen dialysis centers and associated nephrology practices have been working together since early 2019. In this session, the interdisciplinary faculty (two nephrologists with palliative care specialty boards, a nephrology social worker, a nephrology nurse quality improvement advisor, and a palliative care policy analyst) will share lessons in implementing evidence-based best practices to improve supportive care delivery for patients with kidney disease. Presenters will 1) review the literature on unmet palliative care needs of this patient population, 2) describe the needs assessment survey results of dialysis personnel (nephrologists, nurse practitioners, social workers, and administrators) at early adopter dialysis centers, and 3) discuss the first-year results of implementation of the Pathways Project. The presenters will highlight both the successes and challenges of the Pathways Project implementation strategy including identification of seriously ill patients with advanced CKD and ESKD, conducting goals of care conversations with them, offering medical management without dialysis to older advanced CKD patients with multiple comorbidities, and tracking changes in healthcare utilization. They will comment on what worked and did not work to achieve buy-in from nephrologists, nephrology NPs, and other team members. This session will offer clear concepts for how to facilitate palliative care program development for patients with advanced CKD and ESRD.