Authors
  • Lara McDowall1,
  • Jenny Kirby1,
  • Michelle Rice1,
  • Ilse Berquier1,
  • Jenny Kirby2,
  • Michelle Rice2,
  • Nashringi Weir2,
  • Louise Purtell1,
  • Louise Purtell3,
  • Louise Purtell4,
  • Helen Healy1,
  • Ann Bonner1,
  • Ann Bonner4,
  • Helen Healy4,
  • Helen Healy5,
  • Ann Bonner3
Organisations
  • Metro North Hospital and Health Service1,
  • Royal Brisbane and Women's Hospital2,
  • Queensland University of Technology (QUT)3,
  • NHMRC Chronic Kidney Disease Centre of Research Excellence4,
  • Queensland Institute of Medical Research5
Year

2020

Excerpt
Introduction

Kidney supportive care (KSC) delivers evidence-based, individualised healthcare for people with advanced stages of chronic kidney disease (CKD) and their families, regardless of treatment pathways. Care is delivered by a transdisciplinary team with skills in renal and palliative medicine.

Objectives

To examine the transdisciplinary approach in KSC, using a case study, to illustrate the team’s roles in delivering care tailored to the complex and changing needs of a person and family, from time of KSC referral to death.

Discussion

The transdisciplinary team approach of KSC utilises the specialist skills of palliative and renal medicine, nursing, pharmacy and social work, working collaboratively together towards the same goals of optimising quality of life, reducing symptom burden and planning for all healthcare eventualities.

A case example is that of Ms X, 79-year-old woman who had chosen conservative management of her end stage renal failure. The KSC team collaboratively provided tailored healthcare utilising the specialist skills of the various KSC clinicians.  The pharmacist provided advice on medication rationalisation and consulted with the palliative care and renal clinicians to assist with complex symptom burden management. The social worker is integral for providing psychosocial and emotional support and assisting with advanced care planning. Ms X and her family had open communication with the team throughout her journey with KSC allowing individualised care. Through combined consultation the team were able to assist with minimising her clinic burden which ultimately increased her quality of life. Ms X and her family were supported with existential and ethical considerations surrounding treatment decisions and planning for end of life care incorporating Ms X’s personal wishes and values. Ms X died peacefully at home, as per wishes, with family and appropriate supports in place.

Conclusion

KSC delivers an evidence-based model of care which unites elements of both renal and palliative medicine specialties to provide tailored healthcare for people with advanced CKD from referral to death. Ms X’s care demonstrates a clear example of how KSC draws on a transdisciplinary team approach to healthcare which is individualised to current and future needs, including planning for end of life care.