Abstract: TH-PO935
Integrating Palliative Care Consultation into a Hemodialysis Unit: A Pilot Study
Session Information
- Geriatric Nephrology: Innovations and Insights
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Geriatric Nephrology
- 1300 Geriatric Nephrology
Authors
- Thamcharoen, Natanong, King Chulalongkorn Memorial Hospital, Bangkok, Bangkok, Thailand
- Asavapujanamanee, Pagaporn, Benchakitti Park Hospital, Bangkok, Thailand
- Phannajit, Jeerath, King Chulalongkorn Memorial Hospital, Bangkok, Bangkok, Thailand
- Susantitaphong, Paweena, King Chulalongkorn Memorial Hospital, Bangkok, Bangkok, Thailand
- Praditpornsilpa, Kearkiat, King Chulalongkorn Memorial Hospital, Bangkok, Bangkok, Thailand
Background
Patients on hemodialysis(HD) are rarely engaged in advance care planning(ACP),resulting in frequent use of invasive treatments that are futile at the end of life.This study aims to assess the impact of integrating palliative care consultations on ACP in a HD unit.
Methods
This single-center, prospective cohort study was conducted at Benchakitti Park General Hospital HD Unit in Bangkok,Thailand.Patients on chronic HD were screened,those who met any of the following criteria were enrolled:Older than 80 years,advanced organ failure,metastatic cancer,and Palliative Performance Score ≤ 40.The enrolled patients were referred to a palliative care specialist if the primary nephrologist agreed(palliative care group,PC);otherwise,they received routine care(routine care group,RC).The study compares these 2 groups for the number of ACP or code status discussions and treatments received at the end of life.
Results
One hundred and twenty-two patients were screened,45 patients(36.9%) were enrolled and followed for 18 months.Mean age was 81.5±9.3 years.As shown in Table1 ,10 out of 45 patients (22.2%)were referred to a palliative care specialist,while 35 patients received routine care.ACP was discussed in all patients in PC group,while none in the RC group had the discussion.Seven patients(70%) in PC group chose DNR/DNI.During the follow-up,10 out of 45 patients(22.2%) died.Of those who died,5 out of 8 patients(62.5%) in the PC group received comfort care at the end of life,while 1 out of 2 patients in the RC who died received comfort care.One patient in PC group who chose DNR/DNI initially had full resuscitation and died.Three patients in the PC group had planned HD withdrawal and died at home.
Conclusion
Significant numbers of patients on chronic HD require palliative care.Integrating palliative care to HD unit can assist patient with ACP.Patients who had palliative care consult had code status addressed more and received less aggressive care at the end of life.
Table 1 Comparison of outcomes between 2 groups