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Abstract
The proportion of patients starting renal replacement therapy who are elderly, dependent and have multiple co-morbidities is the fastest growing chronic kidney disease (CKD) population in Canada. Most professional nephrology organizations recommend that hemodialysis patients should be encouraged to write advance directives (AD). Advance directives or advance care planning (ACP) are terms that refer to instructions given by an individual that state his or her wishes for future medical treatment and personal care. ACP discussions occur infrequently between the hemodialysis patient and the health care team. Failure to initiate ACP discussions is often due to barriers such as comfort level, time constraints and lack of privacy. This paper reports the results of a small (n = 30) continuous quality improvement (CQI) initiative examining the effectiveness of developing and using a pamphlet to introduce the topic of AD with hemodialysis patients and their families.
In this study, it was found that many hemodialysis patients have thought about cardiopulmonary resuscitation (46.6%), mechanical ventilation (63.3%) and withdrawal of dialysis (56.6%). The majority of hemodialysis patients (70%) found that a pamphlet is helpful to introduce the topic of AD.
As a consequence of this CQI initiative, our renal program has further revised the pamphlet and is beginning to incorporate its use in patient care within the hemodialysis unit.
Key Words: advance directives, advance care planning, withdrawal of dialysis, cardiopulmonary resuscitation
Background and rationale
Advance directives (AD) or advance care planning (ACP) are terms that refer to instructions given by an individual that state his or her wishes for future medical treatment and personal care. Pearlman, Cole, Patrick, Starks and Cain (1995) have defined the concept of ACP as "a deliberative process that helps people formulate preferences for future medical care in the event of mental incapacity." Although AD is a similar concept to ACP, it is not an interchangeable term. ACP is an antecedent to AD. Pearlman et al. (1995) have defined the concept of AD as "mechanisms for communicating and/or documenting ACP and are generally instructional (e.g. living wills) and proxy (e.g. durable power of attorney for health care)."
Although the writing of AD by patients with chronic kidney disease (CKD) has been supported by many nephrology organizations, the prevalence of AD among dialysis patients has...