Abstract
Advance care planning is underutilized in patients with dialysis-dependent kidney failure and the provision of high intensity rather than supportive care is a standard practice in most hemodialysis units wherever challenges to incorporating palliative or supportive care into unit processes remain formidable. The practice of advance care planning empowers patients, families and physicians and drives decisions about future treatment that align with patients' values, wishes and changing clinical circumstances. Barriers to incorporating supportive care exist; however, advance care planning optimizes the chance for future care that is smooth, compassionate, timely and supportive. Care that is palliative in nature may be desired by dialysis patients suffering from escalating comorbid illness and ongoing clinical decline. Advance care planning addresses wishes for future treatment and serves as a prerequisite to the provision of patient-centered care. Nephrologists are uniquely poised to promote a culture that incorporates shared decision-making and support for palliative treatment into dialysis unit care.
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