Advance care planning in chronic kidney disease: A survey of current practice in Australia

Luckett, T; Spencer, L; Morton, RL; Pollock, CA; Lam, L; Silvester, W; Sellars, M; Detering, KM; Butow, PN; Tong, A; Clayton, JM

Advance care planning in chronic kidney disease: A survey of current practice in Australia

Luckett, T

Spencer, L Morton, RL Pollock, CA Lam, L

Silvester, W Sellars, M Detering, KM Butow, PN Tong, A Clayton, JM

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Publication Type:: Journal Article
Citation:: Nephrology, 2017, 22 (2), pp. 139 - 149
Issue Date:: 2017-02-01

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Field	Value	Language
dc.contributor.author	Luckett, T https://orcid.org/0000-0001-6121-5409	en_US
dc.contributor.author	Spencer, L	en_US
dc.contributor.author	Morton, RL	en_US
dc.contributor.author	Pollock, CA	en_US
dc.contributor.author	Lam, L https://orcid.org/0000-0001-6183-6854	en_US
dc.contributor.author	Silvester, W	en_US
dc.contributor.author	Sellars, M	en_US
dc.contributor.author	Detering, KM	en_US
dc.contributor.author	Butow, PN	en_US
dc.contributor.author	Tong, A	en_US
dc.contributor.author	Clayton, JM	en_US
dc.date.available	2016-02-05	en_US
dc.date.issued	2017-02-01	en_US
dc.identifier.citation	Nephrology, 2017, 22 (2), pp. 139 - 149	en_US
dc.identifier.issn	1320-5358	en_US
dc.identifier.uri	http://hdl.handle.net/10453/111927
dc.description.abstract	© 2016 Asian Pacific Society of Nephrology Aim: Advance care planning (ACP) in nephrology is widely advocated but not always implemented. The aims of this study were to describe current ACP practice and identify barriers/facilitators and perceived need for health professional education and chronic kidney disease (CKD)-specific approaches. Methods: An anonymous cross-sectional survey was administered online. Nephrology health professionals in Australia and New Zealand were recruited via professional societies, email lists and nephrology conferences. Multiple regression explored the influence of respondents' attributes on extent of involvement in ACP and willingness to engage in future. Results: A total of 375 respondents included nephrologists (23%), nurses (65%), social workers (4%) and others (8%) with 54% indicated that ACP at their workplace was performed ad hoc and 61% poorly. Perceived barriers included patient/family discomfort (84%), difficulty engaging families (83%), lack of clinician expertise (83%) and time (82%), health professional discomfort (72%), cultural/language barriers (65%), lack of private space (61%) and lack of formal policy/procedures (60%). Respondents overwhelmingly endorsed the need for more dialysis-specific ACP programs (96%) and education (95%). Whilst 85% thought ACP would be optimally performed by specially trained staff, comments emphasized that all clinicians should have a working proficiency. Respondents who were more willing to engage in future ACP tended to be non-physicians (odds ratio (OR) 4.96, 95% confidence intervals (CI) 1.74–14.07) and reported a greater need for CKD-specific ACP materials (OR 10.88, 95% CI 2.38–49.79). Conclusion: Advance care planning in nephrology needs support through education and CKD-specific resources. Endorsement by nephrologists is important. A multidisciplinary approach with a gradient of ACP expertise is also recommended.	en_US
dc.relation.ispartof	Nephrology	en_US
dc.relation.isbasedon	10.1111/nep.12743	en_US
dc.subject.classification	Urology & Nephrology	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Health Care Surveys	en_US
dc.subject.mesh	Multivariate Analysis	en_US
dc.subject.mesh	Linear Models	en_US
dc.subject.mesh	Logistic Models	en_US
dc.subject.mesh	Odds Ratio	en_US
dc.subject.mesh	Cross-Sectional Studies	en_US
dc.subject.mesh	Attitude of Health Personnel	en_US
dc.subject.mesh	Attitude to Death	en_US
dc.subject.mesh	Health Knowledge, Attitudes, Practice	en_US
dc.subject.mesh	Professional-Family Relations	en_US
dc.subject.mesh	Physician-Patient Relations	en_US
dc.subject.mesh	Nephrology	en_US
dc.subject.mesh	Education, Medical, Continuing	en_US
dc.subject.mesh	Inservice Training	en_US
dc.subject.mesh	Adult	en_US
dc.subject.mesh	Middle Aged	en_US
dc.subject.mesh	Advance Care Planning	en_US
dc.subject.mesh	Australia	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.subject.mesh	Renal Insufficiency, Chronic	en_US
dc.subject.mesh	Patient Education as Topic	en_US
dc.subject.mesh	Practice Patterns, Physicians'	en_US
dc.title	Advance care planning in chronic kidney disease: A survey of current practice in Australia	en_US
dc.type	Journal Article
utslib.citation.volume	2	en_US
utslib.citation.volume	22	en_US
utslib.for	1103 Clinical Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
utslib.copyright.status	open_access
pubs.issue	2	en_US
pubs.publication-status	Published	en_US
pubs.volume	22	en_US

Abstract:

© 2016 Asian Pacific Society of Nephrology Aim: Advance care planning (ACP) in nephrology is widely advocated but not always implemented. The aims of this study were to describe current ACP practice and identify barriers/facilitators and perceived need for health professional education and chronic kidney disease (CKD)-specific approaches. Methods: An anonymous cross-sectional survey was administered online. Nephrology health professionals in Australia and New Zealand were recruited via professional societies, email lists and nephrology conferences. Multiple regression explored the influence of respondents' attributes on extent of involvement in ACP and willingness to engage in future. Results: A total of 375 respondents included nephrologists (23%), nurses (65%), social workers (4%) and others (8%) with 54% indicated that ACP at their workplace was performed ad hoc and 61% poorly. Perceived barriers included patient/family discomfort (84%), difficulty engaging families (83%), lack of clinician expertise (83%) and time (82%), health professional discomfort (72%), cultural/language barriers (65%), lack of private space (61%) and lack of formal policy/procedures (60%). Respondents overwhelmingly endorsed the need for more dialysis-specific ACP programs (96%) and education (95%). Whilst 85% thought ACP would be optimally performed by specially trained staff, comments emphasized that all clinicians should have a working proficiency. Respondents who were more willing to engage in future ACP tended to be non-physicians (odds ratio (OR) 4.96, 95% confidence intervals (CI) 1.74–14.07) and reported a greater need for CKD-specific ACP materials (OR 10.88, 95% CI 2.38–49.79). Conclusion: Advance care planning in nephrology needs support through education and CKD-specific resources. Endorsement by nephrologists is important. A multidisciplinary approach with a gradient of ACP expertise is also recommended.

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http://hdl.handle.net/10453/111927