open access

Vol 10, No 4 (2016)
Research paper
Published online: 2017-05-19
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Organizational issues and major problems of palliative care concerning treatment of end-stage renal disease in Polish residential hospices and hospital- -based palliative medicine wards

Leszek Pawłowski, Monika Lichodziejewska-Niemierko, Natalia Krzyżaniak
Medycyna Paliatywna w Praktyce 2016;10(4):131-138.

open access

Vol 10, No 4 (2016)
Original articles
Published online: 2017-05-19

Abstract

Background. Patients diagnosed with end-stage renal disease experience a significant level of symptom burden, including pain, nausea and vomiting, inability to urinate, fatigue etc. At this point in disease progression, it is important to establish what types and choices of therapy are most suitable for these patients, in particular, the value of continuing dialysis treatment.

Material and methods. A self-administered questionnaire was distributed among Polish residential hos­pices and hospital based palliative medicine wards. All responses obtained underwent statistical analysis using Pearson’s Chi Square test.

Results. Permanent palliative care facilities, from which 73 out of 166 registered in Poland, took part in the survey. ESRD patients were identified to be cared by 81% of the aforementioned institutions. The most common treatment approach for these patients was highlighted as conservative treatment (68%), followed by hemodialysis (47%), whereas merely 11% provided peritoneal dialysis. Differences between facilities were identified relating to therapeutic recommendations for terminal ESRD patients with residential hospices more likely to recommend dialysis in conjunction with palliative care, whereas palliative wards advocated a withdrawal from dialysis followed by the initiation of palliative care.

Conclusion. All surveyed facilities considered ESRD patients eligible for guaranteed hospice and palliative care services. However, certain changes are needed to improve care for ESRD patients, including: the development of collaborative partnerships between hospices, dialysis centers and nephrologists, devel­opment of guidelines for withdrawing dialysis and applying conservative treatment, introducing better renal-based training for medical personnel as well as the introduction of transparency within rules relating to the financing of these services.

Abstract

Background. Patients diagnosed with end-stage renal disease experience a significant level of symptom burden, including pain, nausea and vomiting, inability to urinate, fatigue etc. At this point in disease progression, it is important to establish what types and choices of therapy are most suitable for these patients, in particular, the value of continuing dialysis treatment.

Material and methods. A self-administered questionnaire was distributed among Polish residential hos­pices and hospital based palliative medicine wards. All responses obtained underwent statistical analysis using Pearson’s Chi Square test.

Results. Permanent palliative care facilities, from which 73 out of 166 registered in Poland, took part in the survey. ESRD patients were identified to be cared by 81% of the aforementioned institutions. The most common treatment approach for these patients was highlighted as conservative treatment (68%), followed by hemodialysis (47%), whereas merely 11% provided peritoneal dialysis. Differences between facilities were identified relating to therapeutic recommendations for terminal ESRD patients with residential hospices more likely to recommend dialysis in conjunction with palliative care, whereas palliative wards advocated a withdrawal from dialysis followed by the initiation of palliative care.

Conclusion. All surveyed facilities considered ESRD patients eligible for guaranteed hospice and palliative care services. However, certain changes are needed to improve care for ESRD patients, including: the development of collaborative partnerships between hospices, dialysis centers and nephrologists, devel­opment of guidelines for withdrawing dialysis and applying conservative treatment, introducing better renal-based training for medical personnel as well as the introduction of transparency within rules relating to the financing of these services.

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Keywords

end-stage renal disease, palliative care, hospice care, withholding treatment, hospices, dialysis

About this article
Title

Organizational issues and major problems of palliative care concerning treatment of end-stage renal disease in Polish residential hospices and hospital- -based palliative medicine wards

Journal

Palliative Medicine in Practice

Issue

Vol 10, No 4 (2016)

Article type

Research paper

Pages

131-138

Published online

2017-05-19

Bibliographic record

Medycyna Paliatywna w Praktyce 2016;10(4):131-138.

Keywords

end-stage renal disease
palliative care
hospice care
withholding treatment
hospices
dialysis

Authors

Leszek Pawłowski
Monika Lichodziejewska-Niemierko
Natalia Krzyżaniak

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