Advance Care Planning in Hemodialysis: Improving patient care

Despite high mortality rates, patients undergoing dialysis do not view themselves as terminally ill and falsely assume they can be kept alive indefinitely on dialysis. Comprehensive care of these patients requires skill in ACP to lay out a set of values and processes for approaching end of life decisions and identify future goals of care. The process may involve discussion, knowledge sharing and informed decision making about future and potential end of life treatment options and preferences (CANNT, 2014). According to CHPCA National Framework (2012), individuals who engage in ACP are more likely to have their end of life wishes known and followed, have fewer life sustaining procedures, and decrease rates of intensive care admissions, therefore have less costly care in the last weeks of life (CHPCA National Framework, 2012). Further, the Ontario renal network (ORN, 2017), has made it a mandate for ACP and goals of care discussion and documentation be part of the care all chronic ESRD patients receive. Comprehensive care of patients with ESRD requires comfort and expertise in ACP, however, there were no standards of care regarding when to initiate or how to facilitate ACP. To support a great need noted in hemodialysis and an ORN initiative a survey was designed to capture the comfort level and gaps in knowledge on ACP among the nurses. Barriers including lack of knowledge, resources and comfort level were identified in the survey which yielded the birth of an ACP working group to assist and empower HD RN’s. ACP through educational sessions, provision of resources and supports including current material, liason building between ethics, updating the admission checklist, and a unit CAP fellowship were among the outcomes which improved patient engaged, decision sharing hence improving patient care.