SAT-312 NEPHROLOGY AND PALLIATIVE CARE COLLABORATION IN THE CARE OF PATIENTS WITH ADVANCED CHRONIC KIDNEY DISEASE: RESULTS OF A CLINICIAN SURVEY

Abstract

Despite calls for integration of palliative care (PC) into the care of patients with chronic kidney disease (CKD) uptake remains low. Interventions that target top priorities in CKD care and address barriers to collaboration are needed. Our team invited all clinicians working in nephrology and palliative care departments (N = 195) at a large academic health center to participate in an on-line survey designed to capture their perspectives regarding facilitators and barriers to collaboration, and top research and clinical priorities in advanced CKD. Response rate = 48.7% (n= 95). Most respondents were registered nurses (65.3%) in nephrology (80%) with over 15 years’ experience (40%). Respondents reported being comfortable caring for patients at or near end-of-life yet inadequately trained to provide comprehensive care. They endorsed the importance of advance care planning and collaboration between nephrology and PC teams, yet both rarely happen. Fragmentation of care was perceived as the main barrier to collaboration. Nephrology clinicians cited patient/family resistance to PC while PC clinicians cited nephrologists’ resistance, as the next significant barrier. Perceptions regarding collaboration facilitation differed; nephrology clinicians identified patient/family education as the most important facilitator while PC clinicians identified clinician education as the most important facilitator. Top clinical priorities also differed. PC clinicians reported pain/symptom management as taking priority while nephrology clinicians identified caregiver/family support. Developing interventions to support treatment-related decision making was the top research priority for both groups. Additional studies to capture patients’ and families’ perspectives and examine end-of-life care, which are underway, will provide a comprehensive picture. Results will inform the development of targeted interventions.