Clinicians’ Perceptions of Collaborative Palliative Care Delivery in Chronic Kidney Disease

• Type of Material: Article
• Authors: Natalie C. Ernecoff, RAND Corporation; Lindsay F. Bell, University of Pittsburgh; Robert M. Arnold, University of Pittsburgh; Christopher M. Shea, University of North Carolina Chapel Hill; Galen E. Switzer, University of Pittsburgh; Manisha Jhamb, University of Pittsburgh; Jane O. Schell, University of Pittsburgh; Dio Kavalieratos, Emory University
• Language: English
• Date: 2022-08-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jpainsymman.2022.04.167
• Title of Journal or Parent Work: Journal of Pain and Symptom Management
• Volume: 64
• Issue: 2
• Start Page: 168
• End Page: 177
• Grant/Funding Information: This work was supported by NIH TL1 TR001858.
• Keywords: end-stage kidney disease; Nephrology; Hospice and Palliative Care Nursing; Palliative Care; Delivery of Health Care; Renal Insufficiency, Chronic; nephrology; Humans; Health care delivery
• Research Categories: Health Sciences, Health Care Management; Health Sciences, Medicine and Surgery

Abstract

Context: Guidelines recommend palliative care for patients with chronic kidney disease (CKD), who experience a high pain and symptom burden, and receive intensive treatments that often do not align with their values. A lack of scalable specialty palliative care services has prompted calls for attention to primary palliative care, delivered in primary care and nephrology settings. Objectives: The objectives of this study were to 1) describe expectations for care to meet the palliative care needs of people living with CKD, and limitations to meeting those expectations in the current model, and 2) identify potential interventions to meet patients’ palliative care needs. Methods: We conducted semi-structured interviews with clinicians from primary care, nephrology, and palliative care to assess 1) reasonable expectations for meeting palliative needs, 2) barriers to integrating primary palliative care, and 3) potential intervention points. Results: Clinicians discussed their expectations for high-quality communication (e.g., discussing disease understanding, assessing goals of care) and better integration of palliative care services. Clinicians expressed barriers to delivering that care, including poor inter-clinician communication. To address barriers, clinicians outlined potential intervention points, such as building collaborative models of care, and structural triggers to identify patients who may be appropriate for palliative care. Conclusion: Interventions to address gaps in palliative care delivery for people living with CKD should incorporate systematic identification of patients with palliative care needs and structural mechanisms to meeting those needs via specialty and primary palliative care.