Advance care planning for adults with CKD: A systematic integrative review

Luckett, T; Sellars, M; Tieman, J; Pollock, CA; Silvester, W; Butow, PN; Detering, KM; Brennan, F; Clayton, JM

Advance care planning for adults with CKD: A systematic integrative review

Luckett, T

Sellars, M Tieman, J Pollock, CA Silvester, W Butow, PN Detering, KM Brennan, F Clayton, JM

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Publication Type:: Journal Article
Citation:: American Journal of Kidney Diseases, 2014, 63 (5), pp. 761 - 770
Issue Date:: 2014-01-01

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Field	Value	Language
dc.contributor.author	Luckett, T https://orcid.org/0000-0001-6121-5409	en_US
dc.contributor.author	Sellars, M	en_US
dc.contributor.author	Tieman, J	en_US
dc.contributor.author	Pollock, CA	en_US
dc.contributor.author	Silvester, W	en_US
dc.contributor.author	Butow, PN	en_US
dc.contributor.author	Detering, KM	en_US
dc.contributor.author	Brennan, F	en_US
dc.contributor.author	Clayton, JM	en_US
dc.date.available	2013-12-17	en_US
dc.date.issued	2014-01-01	en_US
dc.identifier.citation	American Journal of Kidney Diseases, 2014, 63 (5), pp. 761 - 770	en_US
dc.identifier.issn	0272-6386	en_US
dc.identifier.uri	http://hdl.handle.net/10453/121451
dc.description.abstract	Background Recent clinical practice guidelines have highlighted the importance of advance care planning (ACP) for improving end-of-life care for people with chronic kidney disease (CKD). Study Design We conducted a systematic integrative review of the literature to inform future ACP practice and research in CKD, searching electronic databases in April 2013. Synthesis used narrative methods. Setting & Population We focused on adults with a primary diagnosis of CKD in any setting. Selection Criteria for Studies We included studies of any design, quantitative or qualitative. Interventions ACP was defined as any formal means taken to ensure that health professionals and family members are aware of patients' wishes for care in the event they become too unwell to speak for themselves. Outcomes Measures of all kinds were considered of interest. Results 55 articles met criteria reporting on 51 discrete samples. All patient samples included people with CKD stage 5; 2 also included patients with stage 4. Seven interventions were tested; all were narrowly focused and none was evaluated by comparing wishes for end-of-life care with care received. One intervention demonstrated effects on patient and family outcomes in the form of improved well-being and anxiety following sessions with a peer mentor. Insights from qualitative studies that have not been used to inform interventions include the importance of instilling patient confidence that their advance directives will be enacted and discussing decisions about (dis)continuing dialysis therapy separately from "aggressive" life-sustaining treatments (eg, ventilation). Limitations Although quantitative and qualitative findings were integrated according to best practice, methods for this are in their infancy. Conclusions Research on ACP in patients with CKD is limited, especially intervention studies. Interventions in CKD should attend to barriers and facilitators at the levels of patient, caregiver, health professional, and system. Intervention studies should measure impact on compliance with patient wishes for end-of-life care.	en_US
dc.relation.ispartof	American Journal of Kidney Diseases	en_US
dc.relation.isbasedon	10.1053/j.ajkd.2013.12.007	en_US
dc.subject.classification	Urology & Nephrology	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Terminal Care	en_US
dc.subject.mesh	Advance Care Planning	en_US
dc.subject.mesh	Quality Indicators, Health Care	en_US
dc.subject.mesh	Renal Insufficiency, Chronic	en_US
dc.title	Advance care planning for adults with CKD: A systematic integrative review	en_US
dc.type	Journal Article
utslib.citation.volume	5	en_US
utslib.citation.volume	63	en_US
utslib.for	1103 Clinical Sciences	en_US
utslib.for	1117 Public Health and Health Services	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
utslib.copyright.status	closed_access
pubs.issue	5	en_US
pubs.publication-status	Published	en_US
pubs.volume	63	en_US

Abstract:

Background Recent clinical practice guidelines have highlighted the importance of advance care planning (ACP) for improving end-of-life care for people with chronic kidney disease (CKD). Study Design We conducted a systematic integrative review of the literature to inform future ACP practice and research in CKD, searching electronic databases in April 2013. Synthesis used narrative methods. Setting & Population We focused on adults with a primary diagnosis of CKD in any setting. Selection Criteria for Studies We included studies of any design, quantitative or qualitative. Interventions ACP was defined as any formal means taken to ensure that health professionals and family members are aware of patients' wishes for care in the event they become too unwell to speak for themselves. Outcomes Measures of all kinds were considered of interest. Results 55 articles met criteria reporting on 51 discrete samples. All patient samples included people with CKD stage 5; 2 also included patients with stage 4. Seven interventions were tested; all were narrowly focused and none was evaluated by comparing wishes for end-of-life care with care received. One intervention demonstrated effects on patient and family outcomes in the form of improved well-being and anxiety following sessions with a peer mentor. Insights from qualitative studies that have not been used to inform interventions include the importance of instilling patient confidence that their advance directives will be enacted and discussing decisions about (dis)continuing dialysis therapy separately from "aggressive" life-sustaining treatments (eg, ventilation). Limitations Although quantitative and qualitative findings were integrated according to best practice, methods for this are in their infancy. Conclusions Research on ACP in patients with CKD is limited, especially intervention studies. Interventions in CKD should attend to barriers and facilitators at the levels of patient, caregiver, health professional, and system. Intervention studies should measure impact on compliance with patient wishes for end-of-life care.

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http://hdl.handle.net/10453/121451