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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
Affiliations- Department of Palliative Medicine, Medical University of Gdańsk
- University of Technology Sydney, Graduate School of Health (Pharmacy), Broadway, NSW, Sydney Australia
open access
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.
Keywords
end-stage renal disease, palliative care, hospice care, withholding treatment, hospices, dialysis
About this articleTitle
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
Article type
Research paper
Pages
131-138
Published online
2017-05-19
Page views
601
Article views/downloads
657
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
References (21)- Kidney Health Australia. Statistics — Chronic Kidney Dise- ase in Australia. 2016. http:// kidney.org.au/health-professionals/prevent/statistics ( 18/10/2016).
- Rutkowski B. Przewlekła choroba nerek (PChN) — wyzwa- nie XXI wieku. Przew Lek. 2007; 2: 80–88.
- Rutkowski B, Lichodziejewska-Niemierko M, Grenda R, et al. Raport o stanie leczenia nerkozastępczego w Polsce— 2011. Gdańsk: Drukonsul. ; 2014.
- Rutkowski B. Wyprzedzające przeszczepienie nerek — naj- lepsza metoda leczenia nerkozastępczego. Przew Lek. 2012; 1: 50–53.
- O’Connor N., Kumar P. Conservative Management of En- d-Stage Renal Disease without Dialysis: A Systematic Re- view. Journal of Palliative Medicine. 2012; 15(2): 228–235.
- Buss T, Lichodziejewska-Niemierko M. Opieka paliatywna w Polsce — od idei do praktyki (również lekarza rodzin- nego). Forum Medycyny Rodzinnej. 2008; 3: 277–285.
- Gunda S, Thomas M, Smith S. National survey of palliative care in end-stage renal disease in the UK. Nephrol Dial Transplant. 2005; 20(2): 392–395.
- Gamondi C, Galli N, Schönholzer C, et al. Frequen- cy and severity of pain and symptom distress among patients with chronic kidney disease receiving dialy- sis. Swiss Med Wkly. Epub ahead of print 22 Feb 2013. DOI:10 4414/smw. 2013; 13750: 9.
- Kurella Tamura M., Cohen L. Should there be an expanded role for palliative care in end-stage renal disease? Curr Opin Nephrol Hypertens. 2010; 19(6): 556–560.
- Lichodziejewska-Niemierko M. Integration of palliative care with other medical specialties — opinions of nephrolo- gists. Advances in Palliative Medicine, 2008. 3: p. : 137–142.
- Morton RL, Tong A, Howard K, et al. The views of patients and carers in treatment decision making for chronic kidney disease: systematic review and thematic synthesis of qualitative studies. BMJ. 2010; 340(jan19 2): c112.
- Hobson K, Gomm S, Murtagh F, et al. National survey of the current provision of specialist palliative care services for patients with end-stage renal disease. Nephrol Dial Transplant. 2011; 26(4): 1275–1281.
- Ciałkowska-Rysz A. Sytuacja i wyzwania opieki paliatywnej w Polsce. Medycyna Paliatywna. 2009; 1: 22–26.
- Jagielski D, Graczyk M, Jagielska A, et al. Czy jest miejsce dla zespołu wspierającego opieki paliatywnej w „ostrym” szpitalu? Analiza działalności Zespołu Wspierającego Opie- ki Paliatywnej w Szpitalu Uniwersyteckim w Bydgoszczy w latach 2002–2006. Medycyna Paliatywna w Praktyce. 2008; 2(4): 177–182.
- Murtagh F, Addington-Hall J, Edmonds P, et al. Symptoms in Advanced Renal Disease: A Cross-Sectional Survey of Symptom Prevalence in Stage 5 Chronic Kidney Disease Ma- naged without Dialysis. J Palliat Med. 2007; 6: 1266–1276.
- Lichodziejewska-Niemierko M. Opieka paliatywna nad chorym z przewlekłą chorobą nerek. Medycyna Paliatywna w Praktyce. 2007; 2: 61–65.
- Fassett R, Robertson I, Mace R, et al. Palliative care in end-stage kidney disease. Nephrology (Carlton. 2011; 16(1): 4–12.
- Birmelé B, François M, Pengloan J, et al. Death after withdrawal from dialysis: the most common cause of death in a French dialysis population. Nephrol Dial Transplant. 2004; 19(3): 686–691.
- Holley J. End-of-life Issues in End-stage Renal Disease. US Nephrology. 2008; 3(1): 78–80.
- Brown E, Chambers E, Eggeling C. Palliative care in nephrology. Nephrol Dial Transplant. 2008; 23: 789–791.
- Ellwood AD, Jassal SV, Suri RS, et al. Early dialysis initiation and rates and timing of withdrawal from dialysis in Canada. Clin J Am Soc Nephrol. 2013; 8(2): 265–270.
