Abstract: TH-PO937
Kidney Palliative Care in the Outpatient Setting
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
- Gelfand, Samantha L., Brigham and Women's Hospital, Boston, Massachusetts, United States
- Sciacca, Kate, Brigham and Women's Hospital, Boston, Massachusetts, United States
Background
Patients with advanced kidney disease have notable unmet palliative care needs that can affect quality of life, coping, and caregiver distress. In the United States, most outpatient specialty palliative care is devoted to patients with cancer. Few patients with advanced kidney disease have access to outpatient longitudinal palliative care. At our tertiary academic medical center, an interprofessional specialty palliative care team called KidneyPal has operated in the inpatient setting since 2019. KidneyPal developed the KidneyPal Outpatient Program (KPOP) to define and meet the palliative care needs of seriously ill outpatients with kidney disease.
Methods
We conducted a manual chart review of electronic medical records of patients seen in KPOP from October 2022-October 2023. We maintained a panel that lists all patients who have received care from KidneyPal in both inpatient and outpatient settings.
Results
Over one year, we convened 48 half-day KPOP clinic sessions. Half of these clinic sessions were staffed by a physician and nurse practitioner together, and half by the nurse practitioner alone. An average of 2.8 patients were seen per clinic session (range 0-6). A total of 138 visits occurred for a total of 63 unique patients. Mean patient age was 71.1 (range 23-91 years). Nineteen patients (30%) died during this period. Thirty-one patients (49%) were also cared for during hospitalization by the inpatient branch of the KidneyPal team. Thirteen patients (20%) elected conservative kidney management over dialysis for the treatment of kidney failure. Eleven patients (17%) received > 1 opioid prescription for the treatment of severe refractory pain.
Conclusion
Outpatient kidney palliative encompasses symptom management and decision support regarding treatment options for kidney failure. The patient population was seen in outpatient kidney palliative care is older and experiences high mortality rates. A substantial proportion may opt for conservative kidney management over dialysis if offered the choice. Approximately half of patients who received outpatient longitudinal palliative care in the clinic experienced hospitalizations during which they required inpatient palliative care consultation as well. Models of kidney palliative care should consider including outpatient resources to enhance care continuity and longitudinal relationships.