Insight Into Advance Care Planning for Patients on Dialysis

CONTEXT: Advance care planning is not included in regular clinical care for patients on dialysis. Insight into life-sustaining treatment preferences and communication about the end-of-life care is necessary to develop interventions to improve advance care planning for patients on dialysis. OBJECTIVES: This cross-sectional observational study aimed to understand the preferences for life-sustaining treatments of outpatients on dialysis and to study the quality of patient-physician communication about the end-of-life care and barriers and facilitators to this communication. METHODS: The following outcomes were assessed in 80 clinically stable dialysis patients: demographics, clinical characteristics, life-sustaining treatment preferences (cardiopulmonary resuscitation and mechanical ventilation, and Willingness to Accept Life-Sustaining Treatment instrument), preference for site of death, quality of communication (Quality of Communication questionnaire), and barriers and facilitators to communication about the end-of-life care (Barriers and Facilitators Questionnaire). RESULTS: Patients were able to indicate their preferences for life-sustaining treatments and site of death. Preferences for life-sustaining treatments depend on the specific treatment, the expected outcome of treatment, and likelihood of an adverse outcome. Life-sustaining preferences were discussed with the nephrologist by 30.3% of the patients. Quality of the patient-physician communication about the end-of-life care was rated poor. This study identified several barriers and facilitators to the end-of-life care communication. CONCLUSION: Patients should receive information about treatment burden, expected outcome, and the likelihood of an adverse outcome when discussing life-sustaining treatments. Quality of patient-physician communication about the end-of-life care needs to improve. Barriers and facilitators to communication about the end-of-life care provide direction for future interventions to facilitate advance care planning for patients on dialysis.