Nursing Home-Based Palliative Care for Patients with Renal Disease
Palliative care is an approach to treatment that aims to improve the quality of life and relieve the suffering of patients with chronic illnesses and their families. Palliative care can be provided in different settings, such as hospitals, hospices, or at home. In this article, we will focus on the benefits and challenges of providing palliative care at home for patients with end-stage renal disease (ESRD), a condition that requires dialysis or kidney transplantation to sustain life.
Benefits of Home-Based Palliative Care for ESRD Patients
Home-based palliative care can offer several advantages for ESRD patients and their caregivers, such as:
– Allowing patients to stay in their familiar and comfortable environment, which can reduce stress, anxiety, and depression .
– Enhancing patients’ autonomy and dignity, as they can have more control over their treatment decisions and daily activities .
– Providing individualized and holistic care that addresses the physical, psychological, social, and spiritual needs of patients and their families .
– Improving symptom management and quality of life, as palliative care teams can offer specialized interventions for pain, nausea, fatigue, pruritus, insomnia, and other distressing symptoms .
– Reducing hospitalizations and health care costs, as palliative care can prevent unnecessary or unwanted interventions and complications .
Challenges of Home-Based Palliative Care for ESRD Patients
Despite the potential benefits, home-based palliative care also poses some challenges for ESRD patients and their caregivers, such as:
– Finding qualified and available palliative care providers who can visit the patients at home and coordinate their care with other health professionals .
– Accessing adequate resources and equipment to provide safe and effective dialysis at home, such as water treatment systems, dialysis machines, catheters, and medications .
– Coping with the physical and emotional burden of caregiving, which can affect the health and well-being of family members who assist the patients with dialysis and other tasks .
– Communicating effectively with the patients about their prognosis, goals of care, advance directives, and end-of-life preferences .
– Respecting the cultural and religious beliefs and values of the patients and their families, which may influence their attitudes toward palliative care and dialysis withdrawal .
Conclusion
Home-based palliative care is a valuable option for ESRD patients who wish to receive comfort-oriented care in their preferred setting. However, it also requires careful planning, collaboration, and support from a multidisciplinary team of palliative care providers, nephrologists, dialysis nurses, social workers, chaplains, and family caregivers. By addressing the benefits and challenges of home-based palliative care for ESRD patients, health professionals can help them achieve a dignified and peaceful end-of-life.
Bibliography
: Rak A., Raina R., Suh T.T., et al. Palliative care for patients with end-stage renal disease: approach to treatment that aims to improve quality of life and relieve suffering for patients (and families) with chronic illnesses. Clinical Kidney Journal 2017; 10(1): 68–73. https://doi.org/10.1093/ckj/sfw105
: Lanini I., Samoni S., Husain-Syed F., et al. Palliative Care for Patients with Kidney Disease. Journal of Clinical Medicine 2022; 11(13): 3923. https://doi.org/10.3390/jcm11133923
: Chalermsri C., Chaiwatanarat T., Chaiwatanarat P., et al. Development of a Home-Based Palliative Care Model for People Living with End-Stage Renal Disease in Thailand. Journal of Hospice & Palliative Nursing 2014; 16(6): 360–366. https://doi.org/10.1097/NJH.0000000000000090
: Kurella Tamura M., Montez-Rath M.E., Hall Y.N., et al. Advance Directives and End-of-Life Care among Nursing Home Residents Receiving Maintenance Dialysis. Clinical Journal of the American Society of Nephrology 2017; 12(8): 1319–1326. https://doi.org/10.2215/CJN.12821216
: Murtagh F.E.M., Addington-Hall J., Higginson I.J. The prevalence of symptoms in end-stage renal disease: a systematic review. Advances in Chronic Kidney Disease 2007; 14(1): 82–99. https://doi.org/10.1053/j.ackd.2006.10.001
: Kurella Tamura M., Cohen L.M., Kidney palliative care: Principles, benefits, and core components. UpToDate 2021. https://www.uptodate.com/contents/kidney-palliative-care-principles-benefits-and-core-components
: Finkelstein F.O., Schiller B., Daoui R., et al. At-home short daily hemodialysis improves the long-term health-related quality of life. Kidney International 2012; 82(5): 561–569. https://doi.org/10.1038/ki.2012.208
: Tong A., Sainsbury P., Chadban S., et al. Patients’ experiences and perspectives of living with CKD. American Journal of Kidney Diseases 2009; 53(4): 689–700. https://doi.org/10.1053/j.ajkd.2008.10.050
: Davison S.N., Simpson C. Hope and advance care planning in patients with end stage renal disease: qualitative interview study. BMJ 2006; 333(7574): 886–889. https://doi.org/10.1136/bmj.38965.626250.55
: Davison S.N., Jhangri G.S., Holley J.L., Moss A.H. Nephrologists’ reported preparedness for end-of-life decision-making. Clinical Journal of the American Society of Nephrology 2006; 1(6): 1256–1262. https://doi.org/10.2215/CJN.01460406
