SP785INTEGRATION OF ADVANCE CARE PLANNING INTO STANDARD DIALYSIS CARE

Abstract

INTRODUCTION AND AIMS: Number of frailty patients with advanced chronic kidney disease is growing and for many of them the beginning or continuation of dialysis is associated with a high risk of short-term mortality or worsening of functional status. Estimation of prognosis is not routinely discussed with CKD patients. There is also lack of awarness of ESRD as a life-limiting illness. Patients preferences concernig end-of-life care are often unmet. Integration of individualised advance care planning discussions in standard nephrological care early and throughout the illness allows patients to avoid unwanted life-sustained therapies. It helps health-care professionals to provide treatments that align with patients values and preferences. Advance care planning (ACP) discussions help the patient to understand the illness, to choose treatment options and to prepare him / her for decision-making in a deteriorating condition. ACP is guided by respect for the patient's autonomy and dignity. METHOD(S): Two years ago we have started with integration of supportive care into standard nephrological care at our department. One of our goals was to ensure that all patients who are interested have access to ACP discussions. Prevalent patients on dialysis received self-reported questionnaire concerning their needs to know more details about their health status, treatment options, prognosis, end-of-life issues, possibility to withdraw from dialysis, family involvement in decision making, formalize ACP. RESULT(S): 65 patients were enrolled between March 1 and June 30, 2017 . The mean age and standard deviation was 6869 years. 29 patients (44, 61 %) were aware of possibility to formalize ACP. 52 patients ( 80%) wanted to take active part in treatment decision making. 16 patients ( 24,61%) wished to discuss end-of-life care with health-care professional. 30 patients ( 46,15%) were aware of posibility to withdraw from dialysis. Although some patients reported a desire to discuss their health, prognosis, treatment options, future care and end-of-life issues, for some these discussions were not welcomed. The questionnaire helped us to identify patients who are willing to discuss and even formalize ACP ( 11 patients finally formalize ACP, 16,92%). CONCLUSION(S): What we consider to be important is that discussions on future care have opened up within patients' families.Opening end-of-life care issues helped patients, family members and health-care professionals to be more satisfied with chosen treatment options. Reluctancy to open these discussions were also on side of health-care professionals. Appropriate training and education of renal staff is necessarily for integration of timely, sensitive and regular advance care planning discussions.ACP has the potential to improve and optimise care for this population.