Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related...
Transcript of Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related...
![Page 1: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/1.jpg)
Renal Palliative Care
DNT Meeting ‐March 28 2011
Frank BrennanPalliative Care PhysicianDepartment of Renal MedicineSt George Hospital, Sydney
![Page 2: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/2.jpg)
• What is Palliative Care ?
• The potential role of Palliative Care in Nephrology
• A developing model
![Page 3: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/3.jpg)
What is Palliative Care ?
![Page 4: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/4.jpg)
WHO definition (2002)
Palliative Care is an approach which improves the quality of life of patients and their families facing life‐threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
![Page 5: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/5.jpg)
What possible role does Palliative Care play in End Stage Renal Failure ?
![Page 6: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/6.jpg)
In Australia – the mean age of commencement on Renal Replacement therapy is 60.4 years (ANZDATA Registry 2009 Report)
Increasing number of patients returning to dialysis after transplant failure.
![Page 7: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/7.jpg)
The age cohort that has the greatest prevalence is the 65‐84 year old group.
![Page 8: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/8.jpg)
ESRD patients
Overall patients with ESRD with or without RRT have a reduced life expectancy compared to age‐matched controls.
![Page 9: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/9.jpg)
DIALYSIS
For patients on dialysis 15.4 % die each year (ANZDATA Registry 2008 Report)
![Page 10: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/10.jpg)
For those aged 75 years and older that figure is 25 %
![Page 11: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/11.jpg)
The circumstances in which patients with ESRD die varies considerably
![Page 12: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/12.jpg)
If it is an expected death (eg. after the cessation of dialysis) the management of the dying phase is crucial
and the manner of that dying will be remembered forever by the family
![Page 13: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/13.jpg)
Patients with ESRD have a significant symptom burden related to both the disease itself and other co‐morbidities
![Page 14: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/14.jpg)
Overall QoL is very resistant to significant change
![Page 15: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/15.jpg)
Palliative Care/ a palliative approach can play an important role throughout the course of ESRD
![Page 16: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/16.jpg)
Timing of involvement
• Purely Conservative Management
• Pre‐Dialysis
• Dialysis
• Withdrawal from Dialysis
• Terminal phase
![Page 17: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/17.jpg)
Realistically, given issues of manpower,it may not be possible for a Palliative Care health professional to be present in everyRenal Unit
![Page 18: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/18.jpg)
What are the core competencies in a “Palliative approach” to patients with ESRD ?
![Page 19: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/19.jpg)
4 Pillars of a Palliative approach
• Communication
• Symptom management
• Psychosocial support
• Care of the dying patient
![Page 20: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/20.jpg)
Conservative management of ESRD
![Page 21: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/21.jpg)
If this is being raised as an option :
What does a Conservative pathway mean ?
What is its content ?
Can we make predictions about theircourse ?
![Page 22: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/22.jpg)
Challenge is to ensure that this pathway of management is not seen as “second best” or inadequate
but is thorough, systematic and evidenced‐based
![Page 23: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/23.jpg)
Renal Medicine Palliative approach
Calcium/Phosphate Symptom management Anaemia Fluid balance Psychosocial support
Care of the dying
![Page 24: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/24.jpg)
What would be nature and shape of a collaboration between the Renal Medicine and Palliative Medicine ?
![Page 25: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/25.jpg)
One Model
![Page 26: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/26.jpg)
St George Hospital, Sydney
Collaboration between the Renal Medicine and Palliative Medicine Departments.
![Page 27: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/27.jpg)
1. Formation of a Renal Medicine – Palliative Care Working Group
![Page 28: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/28.jpg)
2. Formation of a Renal Supportive Care Clinic
March 2009
![Page 29: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/29.jpg)
• Held every week
• Held in the Renal Unit
• Palliative Care Consultant, Advanced Trainee in Renal Medicine, Renal Clinical Nurse Specialist and Renal Social Worker
![Page 30: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/30.jpg)
All patients with ESRD according to needs
![Page 31: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/31.jpg)
Main categories of patients who are referred to the clinic :
• Patients who are on a conservative pathway
• Patients who need assistance in decision making around choosing dialysis or not
• Patients who are on dialysis and have cancer or other terminal conditions.
![Page 32: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/32.jpg)
• Patients on dialysis who are experiencing symptoms which are difficult to manage
• Patients on dialysis who need assistance in decision making regarding withdrawing or continuing with dialysis
![Page 33: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/33.jpg)
• Focus on symptom management
• Psychosocial support
• Preliminary discussions on ACP
![Page 34: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/34.jpg)
3. Research
![Page 35: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/35.jpg)
4. Twice weekly ward rounds of in‐patient Renal patients according to needs
![Page 36: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/36.jpg)
5. Teaching programme for Junior Medical Staff, including Nephrology Trainees on all aspects of Renal‐Supportive Care
![Page 37: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/37.jpg)
6. Advance Care Planning
![Page 38: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/38.jpg)
7. Preparation of documents :
(a) End of Life Pathway for Renal Patients
(b) Commonly used Palliative medications in the context of CKD
(c) A Renal‐Palliative Care Reader
![Page 39: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/39.jpg)
8. Annual Renal Memorial Service
![Page 40: Renal Palliative Care - nephrology.edu.au...Palliative Care is an approach which ... burden related to both the disease itself and ... Twice weekly ward rounds of in‐patient Renal](https://reader033.fdocuments.us/reader033/viewer/2022052723/5f0f18c47e708231d4427962/html5/thumbnails/40.jpg)
Conclusion
• A “palliative approach” may be adopted at any stage in the course of CKD
• There are several aspects to that approach
• One model of collaboration