End of life care; In patients with advanced chronic kidney disease (CKD), receiving high intensity care before death was linked with lower family satisfaction with care, while receiving palliative and hospice care was associated with greater family satisfaction. The findings, which appear in an upcoming issue of CJASN, raise concern that the intensive patterns of care direct; so at life extension rather than comfort received by many of these patients near the end of life may reflect low quality care.
End of life care for patients
To examine how patterns of care at the end of life for patients; with advance CKD relate to their families’ perceptions of their care, Claire Richards, Ph.D. RN (Department of Veterans Affairs and University of Washington School of Public Health) and her colleagues analyze information from a survey administer to 5,435 bereave family members of patients with advance CKD who died in Department of veterans Affairs’ facilities between 2009 and 2015.
The analysis reveal that 54% of patients spent 2 or more weeks in the hospital in the last 90 days of life; so 34% receive an intensive procedure in the last 30 days, 47% were admit to the intensive care unit in the last 30 days; so 36% were receiving hospice services at the time of death; also 38% receive a palliative care consultation in the last 90 days. Most patients (55%) had not been treat with dialysis; 12% had received acute dialysis, and 34% had receive maintenance dialysis.
Chronic kidney disease
Patients treat with acute or maintenance dialysis had more intensive patterns of end-of-life care than those not treat with dialysis. After adjusting for patient and facility characteristics; receiving more intensive patterns of end-of-life care and receiving maintenance (but not acute) dialysis were with lower overall family ratings of care; whereas receiving palliative care and hospice services was with higher ratings.
“In general, patients who receive more aggressive end-of-life care focus on life extension; which including spending more time in the hospital and receiving intensive procedures such as CPR and mechanical ventilation had less favorable family ratings of end-of-life care while those who receive palliative care especially hospice services had more favorable ratings,” said Dr. Richards.
“Although family ratings of care were less favorable for patients; so who had on maintenance dialysis than for those not treat with dialysis; so this appear to be explain by their more aggressive patterns of care; also more limit use of palliative care and hospice services.” Among patients with advance CKD, care focus on life extension rather than comfort; which was with lower family ratings of end-of-life care regardless of whether patients had receive dialysis.