Perspectives of Caregivers and Clinicians on a Concurrent Hospice and Dialysis Program: A Qualitative Analysis

Abstract

Most people receiving dialysis are hospitalized in the last month of life, and nearly half of them undergo intensive care. 2 Wong SPY Kreuter W O’Hare AM Treatment Intensity at the End of Life in Older Adults Receiving Long-term Dialysis. Arch Intern Med. 2012; 172: 661-663https://doi.org/10.1001/ARCHINTERNMED.2012.268 Crossref PubMed Scopus (0) Google Scholar Although hospice positively impacts end-of-life outcomes, 3 Kavalieratos D Corbelli J Zhang D et al. Association between palliative care and patient and caregiver outcomes: A systematic review and meta-analysis. JAMA - Journal of the American Medical Association. 2016; 316: 2104-2114https://doi.org/10.1001/JAMA.2016.16840 Crossref PubMed Scopus (0) Google Scholar patients receiving dialysis are half as likely to receive hospice services compared to the general Medicare population. 4 Wachterman MW Hailpern SM Keating NL Tamura MK O’Hare AM Association between hospice length of stay, health care utilization, and medicare costs at the end of life among patients who received maintenance hemodialysis. JAMA Intern Med. 2018; 178: 792-799https://doi.org/10.1001/jamainternmed.2018.0256 Crossref PubMed Scopus (48) Google Scholar Limitations of the Medicare hospice benefit which requires hospices to cover the cost of care related to the terminal diagnosis may serve as a barrier to timely hospice access. We previously described outcomes of a Concurrent Hospice-Dialysis Program that allows patients to continue comfort-focused dialysis while receiving hospice. Enrollees had a longer median hospice length of stay compared to national trends for patients with ESKD (9 days vs. 5 days, respectively), and half of the enrollees received no dialysis treatments after Program enrollment. 4 Wachterman MW Hailpern SM Keating NL Tamura MK O’Hare AM Association between hospice length of stay, health care utilization, and medicare costs at the end of life among patients who received maintenance hemodialysis. JAMA Intern Med. 2018; 178: 792-799https://doi.org/10.1001/jamainternmed.2018.0256 Crossref PubMed Scopus (48) Google Scholar ,5 Ernecoff NC Bursic AE Motter EM Lagnese K Taylor R Schell JO Description and Outcomes of an Innovative Concurrent Hospice-Dialysis Program. Journal of the American Society of Nephrology. 2022; 33: 1942-1950https://doi.org/10.1681/ASN.2-22010064 Crossref Google Scholar This study describes the perspectives of participating caregivers and clinicians.