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Ernecoff NC, Kurtz EC, Pearson EM, Grimes TH, Aldous A, Lupu DE, Schell JO. Advanced Care Planning in Chronic Kidney Disease: Qualitative Impact of the MY WAY Intervention. J Pain Symptom Manage 2024:S0885-3924(24)00801-7. [PMID: 38848793 DOI: 10.1016/j.jpainsymman.2024.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/23/2024] [Accepted: 05/30/2024] [Indexed: 06/09/2024]
Abstract
CONTEXT Despite recommendations for shared decision-making and advanced care planning (ACP) for people with chronic kidney disease (CKD), such conversations are infrequent. The MY WAY educational and patient coaching intervention aimed to promote high-quality ACP. OBJECTIVES This qualitative sub-study sought to gain participant feedback on the MY WAY ACP coaching intervention, and how it impacted their wishes, perceptions of kidney care, and factors that helped them reflect on ACP. METHODS We conducted semi-structured interviews with participants from the intervention arm of the MY WAY study about their prior experience with ACPs in the context of CKD, impressions of the MY WAY intervention, and outcomes of the MY WAY intervention. We conducted a qualitative thematic analysis of transcribed interviews. RESULTS Among 15 intervention participants, the following major themes emerged: 1) Patients with CKD approach ACP with varied experiences; 2) Patients felt the MY WAY coaching intervention supported ACP by reinforcing values; and 3) Patients found the coaching intervention focused on end of life, but not necessarily on decision making regarding CKD. CONCLUSION Participants perceived the coaching intervention to have high utility in facilitating ACP, but had a limited impact on CKD-specific decision-making. These findings suggest that the coach plays a crucial role in comfort with ACP conversations and that ACP readiness and engagement may not correlate with treatment preferences or understanding of CKD treatment decisions.
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Affiliation(s)
| | | | | | | | | | - Dale E Lupu
- George Washington University, Washington, DC, USA
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Kanbay M, Basile C, Battaglia Y, Mantovani A, Yavuz F, Pizzarelli F, Luyckx VA, Covic A, Liakopoulos V, Mitra S. Shared decision making in elderly patients with kidney failure. Nephrol Dial Transplant 2024; 39:742-751. [PMID: 37742209 PMCID: PMC11045282 DOI: 10.1093/ndt/gfad211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Indexed: 09/26/2023] Open
Abstract
'Elderly' is most commonly defined as an individual aged 65 years or older. However, this definition fails to account for the differences in genetics, lifestyle and overall health that contribute to significant heterogeneity among the elderly beyond chronological age. As the world population continues to age, the prevalence of chronic diseases, including chronic kidney disease (CKD), is increasing and CKD frequently progresses to kidney failure. Moreover, frailty represents a multidimensional clinical entity highly prevalent in this population, which needs to be adequately assessed to inform and support medical decisions. Selecting the optimal treatment pathway for the elderly and frail kidney failure population, be it haemodialysis, peritoneal dialysis or conservative kidney management, is complex because of the presence of comorbidities associated with low survival rates and impaired quality of life. Management of these patients should involve a multidisciplinary approach including doctors from various specialties, nurses, psychologists, dieticians and physiotherapists. Studies are mostly retrospective and observational, lacking adjustment for confounders or addressing selection and indication biases, making it difficult to use these data to guide treatment decisions. Throughout this review we discuss the difficulty of making a one-size-fits-all recommendation for the clinical needs of older patients with kidney failure. We advocate that a research agenda for optimization of the critical issues we present in this review be implemented. We recommend prospective studies that address these issues, and systematic reviews incorporating the complementary evidence of both observational and interventional studies. Furthermore, we strongly support a shared decision-making process matching evidence with patient preferences to ensure that individualized choices are made regarding dialysis vs conservative kidney management, dialysis modality and optimal vascular access.
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Affiliation(s)
- Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Carlo Basile
- Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy
| | - Yuri Battaglia
- Department of Medicine, University of Verona, Verona, Italy
- Nephrology and Dialysis Unit, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Furkan Yavuz
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | | | - Valerie A Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Adrian Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center – ‘C.I. Parhon’ University Hospital, and ‘Grigore T. Popa’ University of Medicine, Iasi, Romania
| | - Vassilios Liakopoulos
- Second Department of Nephrology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sandip Mitra
- Manchester Academy of Health Sciences Centre (MAHSC), Manchester University Hospitals and University of Manchester, Manchester, UK
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Berman ME, Lowentritt JE. Chronic kidney disease and value-based care: Lessons from innovation, iteration, and ideation in primary care. Hemodial Int 2024; 28:6-16. [PMID: 37936554 DOI: 10.1111/hdi.13126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 11/09/2023]
Abstract
Value-based primary care has reduced health care costs, improved the quality of rendered care, and enhanced the patient experience. Value-based care emphasizes prevention, outreach, follow-up, patient engagement, and comprehensive, whole-person health. Primary care Accountable Care Organizations have leveraged technology-enabled workflows, practice transformation, and cutting-edge data and analytics to achieve success. These efforts are increasingly aided by predictive modeling used in the context of patient identification and prioritization algorithms. Value-based kidney care programs can glean salient takeaways from successful value-based primary care methods and models. The kidney care community is experiencing unprecedented transformation as novel payer programs and financial models burgeon. The authors contend these efforts can be accelerated by the adoption of techniques honed in value-based primary care. To optimize value-based kidney care, though, nephrology thought leaders must transcend the archetype of value-based primary care. To do so, the nephrology community must: (1) impel behavioral change among fee-for-service adherents; (2) harness emerging policy, guidelines, and quality measures; (3) adopt innovative tools, technologies, and therapies. In aggregating lessons from value-based primary care-and leveraging novel methodologies and approaches-the kidney care community will be better equipped to achieve the quadruple aim for kidney care.
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Anderson E, Goins RT, Haozous EA, Schweinhart A. Testing a Culturally Tailored Advance Care Planning Intervention (MY WAY) for an American Indian Tribe: Protocol for a Quasi-Experimental Waitlist Control Design. JMIR Res Protoc 2023; 12:e50654. [PMID: 38157237 PMCID: PMC10787334 DOI: 10.2196/50654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND American Indian and Alaska Native peoples experience poor end-of-life care, including more hospitalizations and lower use of hospice and do-not-resuscitate orders. Although advance care planning (ACP) can improve end-of-life care, ACP rates are disproportionately low in American Indians and Alaska Natives. OBJECTIVE We culturally tailored and delivered an existing evidence-based ACP program for an American Indian tribal community. Here, we present the protocol for assessing the intervention's feasibility and efficacy. METHODS We measured feasibility via participant recruitment, participants' evaluation (acceptability, appropriateness, comprehension, and satisfaction), and intervention fidelity. Recruitment was measured with participant screening, eligibility, enrollment, and retention. Participant's evaluation of the intervention was measured with surveys. Fidelity was measured with direct observation and the Make Your Wishes About You (MY WAY) Fidelity Checklist Tool. To assess the intervention's efficacy, we used a quasi-experimental waitlist control design with 2 cohorts who were surveyed each on three separate occasions. The intervention's efficacy was assessed by the following: ACP barriers and facilitators as well as ACP self-efficacy, readiness, and completion. RESULTS A total of 166 participants were screened for eligibility; 11 were deemed ineligible, and 155 participants were enrolled in the study. Of those enrolled, 113 completed the intervention and will be included in subsequent analyses. We finalized data collection in January 2023, and analyses are underway. Study enrollment was successful, and we expect that participants will report high levels of acceptability, appropriateness, comprehension, and satisfaction with the intervention. We expect that the intervention was implemented with fidelity and will demonstrate decreases in ACP barriers and increases in ACP facilitators, self-efficacy, readiness, and completion. CONCLUSIONS Enrolling over twice as many participants as we had hoped suggests that members of this tribal community are willing to engage in end-of-life ACP. We were able to implement a waitlist study design to show that a culturally tailored ACP program for a tribal community is feasible. TRIAL REGISTRATION ClinicalTrials.gov NCT05304117; https://clinicaltrials.gov/study/NCT05304117. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50654.
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Affiliation(s)
- Elizabeth Anderson
- Pacific Institute for Research and Evaluation, Chapel Hill, NC, United States
| | - R Turner Goins
- College of Health and Human Sciences, Western Carolina University, Cullowhee, NC, United States
| | - Emily A Haozous
- Pacific Institute for Research and Evaluation, Albuquerque, NM, United States
| | - April Schweinhart
- Pacific Institute for Research and Evaluatoin, Louisville, KY, United States
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Wang T, Ho MH, Xu X, Choi HR, Lin CC. Motivational interviews to enhance advance care plans in older adults: systematic review. BMJ Support Palliat Care 2023:spcare-2023-004424. [PMID: 37709366 DOI: 10.1136/spcare-2023-004424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/21/2023] [Indexed: 09/16/2023]
Affiliation(s)
- Tongyao Wang
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Mu-Hsing Ho
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Xinyi Xu
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Hye Ri Choi
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Chia-Chin Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
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Buur LE, Bekker HL, Madsen JK, Søndergaard H, Kannegaard M, Khatir DS, Finderup J. Patient involvement interventions for patients with kidney failure making end-of-life care decisions: a scoping review. JBI Evid Synth 2023; 21:1582-1623. [PMID: 37278615 DOI: 10.11124/jbies-22-00261] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The objective of this review was to investigate and map empirical evidence of patient involvement interventions to support patients with kidney failure making end-of-life care decisions in kidney services. INTRODUCTION Clinical guidance integrating end-of-life care within kidney failure management pathways varies. Advance care planning interventions aimed at involving patients with kidney failure in their end-of-life care planning are established in some countries. However, there is limited evidence of the other types of patient involvement interventions integrated within services to support patients with kidney failure in making decisions about their end-of-life care. INCLUSION CRITERIA This scoping review included studies exploring patient involvement interventions evaluated for patients with kidney failure considering end-of-life care, their relatives, and/or health professionals in kidney services. Studies of children under the age of 18 years were excluded. METHODS The review was informed by JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review guidelines. MEDLINE, Scopus, Embase, and CINAHL were searched for full-text studies in English, Danish, German, Norwegian, or Swedish. Two independent reviewers assessed the literature against the inclusion criteria. A relational analysis framework was used to synthesize the data extracted from the included studies, and to investigate and map different patient involvement interventions. RESULTS The search identified 1628 articles, of which 33 articles met the inclusion criteria. A total of 23 interventions were described. Interventions targeted patients (n=3); health professionals (n=8); patients and health professionals (n=5); and patients, relatives, and health professionals (n=7). Intervention components included patient resources (eg, information, patient decision aids), consultation resources (eg, advance care planning, shared decision-making), and practitioner resources (eg, communication training). Patient involvement interventions were delivered within hospital-based kidney services. CONCLUSIONS The review identified several ways to support patients with kidney failure to be involved in end-of-life care decisions. Future interventions may benefit from adopting a complex intervention framework to engage multiple stakeholders in the research and design of an intervention for shared decision-making between patients with kidney failure, their relatives, and health professionals about integrating end-of-life care options into their kidney disease management pathway.
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Affiliation(s)
- Louise Engelbrecht Buur
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- ResCenPI - Research Center for Patient Involvement, Aarhus University and Central Denmark Region, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Hilary Louise Bekker
- ResCenPI - Research Center for Patient Involvement, Aarhus University and Central Denmark Region, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Leeds Unit of Complex Intervention Development (LUCID), Leeds Institute of Health Science, University of Leeds, Leeds, UK
| | | | | | | | - Dinah Sherzad Khatir
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- ResCenPI - Research Center for Patient Involvement, Aarhus University and Central Denmark Region, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Kurella Tamura M, Holdsworth L, Stedman M, Aldous A, Asch SM, Han J, Harbert G, Lorenz KA, Malcolm E, Nicklas A, Moss AH, Lupu DE. Implementation and Effectiveness of a Learning Collaborative to Improve Palliative Care for Seriously Ill Hemodialysis Patients. Clin J Am Soc Nephrol 2022; 17:1495-1505. [PMID: 36104084 PMCID: PMC9528276 DOI: 10.2215/cjn.00090122] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 08/11/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES Limited implementation of palliative care practices in hemodialysis may contribute to end-of-life care that is intensive and not patient centered. We determined whether a learning collaborative for hemodialysis center providers improved delivery of palliative care best practices. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Ten US hemodialysis centers participated in a pre-post study targeting seriously ill patients between April 2019 and September 2020. Three practices were prioritized: screening for serious illness, goals of care discussions, and use of a palliative dialysis care pathway. The collaborative educational bundle consisted of learning sessions, communication skills training, and implementation support. The primary outcome was change in the probability of complete advance care planning documentation among seriously ill patients. Health care utilization was a secondary outcome, and implementation outcomes of acceptability, adoption, feasibility, and penetration were assessed using mixed methods. RESULTS One center dropped out due to the coronavirus disease 2019 pandemic. Among the remaining nine centers, 20% (273 of 1395) of patients were identified as seriously ill preimplementation, and 16% (203 of 1254) were identified as seriously ill postimplementation. From the preimplementation to postimplementation period, the adjusted probability of complete advance care planning documentation among seriously ill patients increased by 34.5 percentage points (95% confidence interval, 4.4 to 68.5). There was no difference in mortality or in utilization of palliative hemodialysis, hospice referral, or hemodialysis discontinuation. Screening for serious illness was widely adopted, and goals of care discussions were adopted with incomplete integration. There was limited adoption of a palliative dialysis care pathway. CONCLUSIONS A learning collaborative for hemodialysis centers spanning the coronavirus disease 2019 pandemic was associated with adoption of serious illness screening and goals of care discussions as well as improved documentation of advance care planning for seriously ill patients. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER Pathways Project: Kidney Supportive Care, NCT04125537.
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Affiliation(s)
- Manjula Kurella Tamura
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
- Geriatric Research and Education Clinical Center, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - Laura Holdsworth
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Margaret Stedman
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Annette Aldous
- Milkin Institute School of Public Health, George Washington University, Washington, DC
| | - Steven M. Asch
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
- Center for Innovation to Implementation, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - Jialin Han
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Glenda Harbert
- School of Nursing, George Washington University, Washington, DC
| | - Karl A. Lorenz
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
- Center for Innovation to Implementation, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - Elizabeth Malcolm
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Amanda Nicklas
- School of Nursing, George Washington University, Washington, DC
| | - Alvin H. Moss
- Center for Health Ethics and Law, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Dale E. Lupu
- School of Nursing, George Washington University, Washington, DC
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Analysis of the Effectiveness of Nursing Interventions in Critically Ill Patients in Respiratory Medicine. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:1193282. [PMID: 35126895 PMCID: PMC8808204 DOI: 10.1155/2022/1193282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/28/2021] [Accepted: 12/31/2021] [Indexed: 11/25/2022]
Abstract
Objective To enhance and analyze the clinical effectiveness of implementing quality nursing interventions in the clinical care of critically ill patients in respiratory medicine. Methods Clinical data of respiratory medicine patients treated in our hospital over the years were collected and 96 patients who met the requirements of the purpose of this study and the sample inclusion criteria were selected as the study subjects from the patients treated between April 2019 and January 2020. According to the care methods received by the patients in our hospital, 48 of them who implemented conventional care were used as the control group, and another 48 patients who were given quality care interventions were used as the observation group. The data were statistically recorded and comparatively analyzed for the indicators such as nursing oxygen index, heart rate, and clinical treatment efficiency of patients in both groups. Results Compared with the control group, patients in the observation group who received quality nursing intervention had more significant improvement in blood oxygen index and heart rate after nursing care; the clinical treatment efficiency of patients in the observation group was significantly higher than that of the control group (95.83% vs. 81.25%). The data comparison between the groups showed a significant difference, P < 0.05, which was statistically significant. Conclusion Adding quality nursing interventions to the implementation of conventional care for patients with respiratory diseases can better improve patients' clinical symptoms, accelerate their clinical recovery, improve and enhance prognosis, and further improve clinical outcomes.
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