Best-Laid Plans: Can a "Life-Plan" Improve the Concordance of Kidney Disease Care with Patient Preferences?

• Type of Material: Article
• Authors: Megan Urbanski, Emory University; Laura C Plantinga, Emory University
• Language: English
• Date: 2023-06-01
• Publisher: Wolters Kluwer Health, Inc
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Nephrology
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.34067/KID.0000000000000139
• Title of Journal or Parent Work: Kidney360
• Volume: 4
• Issue: 6
• Start Page: 717
• End Page: 719
• Grant/Funding Information: Funding:None
• Keywords: Kidney Diseases; Patient Preference; Humans
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

The implementation of individualized approaches, incorporating information about patients' preferences for care as well as prognostic and other factors, has been a significant challenge in US dialysis care.1 “One size fits all” approaches have dominated dialysis care in the pay-for-performance era2: For example, the Fistula First initiative3 was predicated on the assumption that an arteriovenous fistula was best for all in-center hemodialysis patients. To address this issue, the National Kidney Foundation recently expanded their Kidney Disease Outcomes Quality Initiative vascular access clinical practice guidelines to include a universal recommendation for an ESKD Life-Plan. The ESKD Life-Plan promotes shared decision-making (SDM) among patients and their dialysis care team as they strategize treatment plans for a lifetime with kidney disease and “specifically considers the patients' current medical situation, current and future life goals, preferences, social support, functional status, and logistics and other practical feasibilities.”4 The recommendation states that the ESKD Life-Plan should be established for those with progressive CKD, estimated glomerular filtration rate <20 ml/min per 1.73 m2, or ESKD and that this Life-Plan should be reviewed, updated, and documented in the patient's medical record at least annually and more frequently as clinically indicated.4 The ESKD Life-Plan has obvious relevance beyond vascular access management, yet the extent of its uptake—and incorporation of patient preferences generally—into the spectrum of care for patients with ESKD and pre-ESKD CKD dialysis remains underexplored.