Advance care planning for patients with ESRD in the context of a renal palliative care clinic

Renal failure is considered as one of the major contributors to chronic disease and morbidity rates in Australia. For patients on dialysis, 15.4% die each year, 36% of these deaths are attributed to ‘social causes’ (ANZDATA Registry 2008 Report). The shift from curative treatment to supportive care, calls for implementation of palliative care principles in a renal context. Thus comprehensive and holistic care for patients with ESRD requires expertise in advance care planning. Ideally, ACP will anticipate circumstances where it is appropriate to cease active dialysis, or in the context of patients who have chosen a conservative management pathway, a palliative approach is adopted.

The renal palliative care clinic is a joint collaboration between the departments of renal medicine and palliative care at St George Hospital, Sydney. This unique clinic has adopted a multidisciplinary framework in an aim to attend to the symptom management, psychosocial, spiritual, advance care planning,and end of life preparation. It was developed as a result of quality of life surveys and palliative care study as part of St George Hospital, Sydney.

In support of the research conducted by Davison (2007) and Holley (2007), the renal palliative care clinic attempts to facilitate the process of advance care planning rather than focusing on a document or a directive. The poster presentation examines how St George Hospital is exploring advance care planning in the context of the renal palliative care clinic in an attempt to inform, educate and support all health professionals in adopting an advance care planning perspective.