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Palliative care initiatives are needed in nephrology, yet implementation is lacking. We created a 6-hour workshop to teach the skills of active listening, responding to emotion, and exploring goals and values to nurses and social workers working in dialysis units. The workshop consisted of interactive didactics and structured role play with trained simulated patients. We assessed preparedness using a Likert scale and utilized paired t tests to measure the impact using a self-assessment survey following the training. Ten nurses and two social workers from six dialysis units completed the training. Mean scores improved in all domains: demonstrating empathie behaviors, responding to emotion and end-of-life concerns, eliciting family's concerns at end-of-life and patient's goals, and discussing spiritual concerns. Further testing in larger samples may help to confirm these results.
Key Words:
Communication skills, palliative care, dialysis, nurse, education, social worker, advance care planning.
There is now increasing recognition of the need for advance care planning (ACP) in nephrology. The Medicare End Stage Kidney Disease (ESKD) program cost in excess of $49 billion in 2018, yet evidence indicates mortality is high and quality of life is low (Davison & Jhangri, 2010; United States Renal Data System [USRDS], 2020). As many as 21% to 61% of patients on maintenance dialysis report regretting the decision to start dialysis, and almost a quarter of patients discontinue dialysis (Davison, 2010; Saeed, 2020; USRDS, 2020). The symptom burden in patients receiving maintenance dialysis is high and includes fatigue, pain, and insomnia, and these symptoms correlate with negative mental and physical quality-of-life scores (Davison &Jhangri, 2010). Patients rely on nephrology nurses and social workers to address symptom bur- den, psychosocial and spiritual needs, and advance care planning (ACP). Yet dialysis nurses and social workers report a lack of education and systemic implementation to meet these palliative care needs (Culp et al., 2016; Davison, 2010).
Lack of communication skills training is a potential barrier to integration palliative care in nephrology. Recent efforts to improve communication skills have focused on nephrologists and fellows. NephroTalk and a program at Harvard are successful communication skills training programs that have used didactics and role play to train nephrology fellows since 2011 (Cohen et al., 2016; Schell et al., 2013; Schell et al., 2018). Dialysis staff, including nurses,...