Kidney Week

Abstract: TH-PO310

Is the Preferred Place of Death Met in Patients on Dialysis? A Systematic Review

Session Information

• Hemodialysis and Frequent Dialysis - 1
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Boereboom, Marc L., Universiteit Maastricht Faculty of Health Medicine and Life Sciences, Maastricht, Limburg, Netherlands

Marc L. Boereboom

• Verbruggen, Joost, Universiteit Maastricht Faculty of Health Medicine and Life Sciences, Maastricht, Limburg, Netherlands

Joost Verbruggen

• Theunissen, Maurice, Center of Expertise for Palliative Care, MUMC+, Maastricht, Limburg, Netherlands

Maurice Theunissen, PhD

• Joosten, Jmh, Division of General Medicine, Department of Internal Medicine, Section of Geriatric Medicine, MUMC+, Maastricht, Limburg, Netherlands

Jmh Joosten, DrMed

• van den Beuken-van Everdingen, Marieke H.j., Center of Expertise for Palliative Care, MUMC+, Maastricht, Limburg, Netherlands

Marieke H.j. van den Beuken-van Everdingen, MS, PhD

• Hemmelder, Marc H., Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, Limburg, Netherlands

Marc H. Hemmelder, MD, PhD

• Bouwmans, Pim, Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, Limburg, Netherlands

Pim Bouwmans, MD, MS, MSc

Background

Dialysis patients’ palliative care needs are frequently unmet. An important aspect of palliative care is to timely determine the preferred place of death. In this study, we questioned what the preferred place of death is in dialysis patients, and whether this is met at time of death.

Methods

A systematic review was performed searching PubMed for studies on palliative care and preferred place of death in adult dialysis patients. Articles were screened by two observers on title, abstract and full text. Risk-of-bias was assessed with a tool for prevalence studies (Hoy et al.).

Results

We included nine studies that reported a preferred place of death. The majority of patients (67-75%) preferred to die out-of-hospital. Janssen et al. reported the preferred place of death in 206 Dutch patients with end-stage organ failure as being at-home in 51%, in a hospital in 30%, in a nursing home or hospice in 10%, and unknown in 9%. Davison et al. observed similar rates of preferred death out-of-hospital in 238 Canadian predialysis patients, 295 dialysis patients and 51 kidney transplant recipients. Other studies did not specify the preferred out-of-hospital place of death. Four studies reported the actual place of death and observed an out-of-hospital death in between 42 and 80% of cases. Out-of-hospital death was reported more frequently in patients who were receiving palliative care, had advance care planning or opted for dialysis withdrawal. Most out-of-hospital deaths occurred at home. Janssen et al. observed that 39% of patients died at their preferred place of death.

Conclusion

A large majority of dialysis patients prefer to die out-of-hospital, yet their preference is often not met at time of death. Advance care planning, palliative care and dialysis withdrawal emerged as factors that promote an out-of-hospital death. Comprehensive documentation of wants, values and needs for palliative care is warranted to enhance alignment with dialysis patients' preferences.