Advance care planning in chronic kidney disease: A survey of current practice in Australia.

Publisher:
Wiley
Publication Type:
Journal Article
Citation:
Nephrology, 2017, 22 (2), pp. 139 - 149
Issue Date:
2017-02
Full metadata record
Files in This Item:
Filename Description Size
CKD_ACPsurveyofcurrentpractice_manuscript_Nephrology-AUTHORS COPY.pdfAccepted Manuscript605.26 kB
Adobe PDF
Advancse care planning (ACP) in nephrology is widely advocated but not always implemented. The aims of this study were to describe current ACP practice, identify barriers/facilitators and perceived need for health professional education and chronic kidney disease (CKD)-specific approaches.An anonymous cross-sectional survey was administered online. Nephrology health professionals in Australia and New Zealand were recruited via professional societies, email lists and nephrology conferences. Multiple regression explored the influence of respondents' attributes on extent of involvement in ACP and willingness to engage in future.375 respondents included nephrologists (23%), nurses (65%), social workers (4%) and others (8%). 54% indicated that ACP at their workplace was performed ad-hoc and 61% poorly. Perceived barriers included patient/family discomfort (84%), difficulty engaging families (83%), lack of clinician expertise (83%) and time (82%), health professional discomfort (72%), cultural/language barriers (65%), lack of private space (61%) and lack of formal policy/procedures (60%). Respondents overwhelmingly endorsed the need for more dialysis-specific ACP programs (96%) and education (95%). Whilst 85% thought ACP would be optimally performed by specially-trained staff, comments emphasized that all clinicians should have a working proficiency. Respondents who were more willing to engage in future ACP tended to be non-physicians (Odds ratio [OR] 4.96, 95% confidence intervals [CI] 1.74-14.07) and reported a greater need for CKD-specific ACP materials (OR 10.88, 95% CI 2.38-49.79).ACP in nephrology needs support through education and CKD-specific resources. Endorsement by nephrologists is important. A multi-disciplinary approach with a gradient of ACP expertise is also recommended.
Please use this identifier to cite or link to this item: