Nephrology and Palliative Care Collaboration in the Care of Patients With Advanced Kidney Disease: Results of a Clinician Survey

Abstract Rationale and Objective Despite calls for integrating palliative care into chronic kidney disease (CKD) care, uptake remains low. The study aim was to describe clinicians' perceptions of the clinical and research priorities in CKD care and the main barriers to collaboration. Study Design This was a descriptive, cross-sectional study, using an on-line survey, developed by clinicians and researchers, as the primary data collection method. Setting and Participants Clinicians in nephrology and palliative care departments (N = 195) at an academic health center in Virginia, were invited to participate. Of the 48.7% who responded (n = 95), most were registered nurses (65.3%) in nephrology (80%) with over 15 years' experience (40%). Predictors Factors including discipline (nursing, social work, physician) and practice area (palliative care or nephrology) were assessed. Outcomes Main outcomes of interest included clinicians' perceptions of the role of palliative care, barriers to collaboration, and the top clinical and research priorities for patients with advanced CKD. Analytic Approach Survey data were analyzed in SPSS, using descriptive statistics. Results Respondents reported being comfortable caring for patients near end-of-life and endorsed advance care planning and collaboration between nephrology and palliative care teams. Yet, both rarely happen. Fragmentation, or poor coordination of care was perceived to be the main barrier to collaboration. Perceptions regarding collaboration facilitation differed; nephrology clinicians identified patient/family education as the most important facilitator while palliative care clinicians identified clinician education as most important. Top clinical priorities differed. Palliative care clinicians reported pain/symptom management as taking priority while nephrology clinicians identified caregiver/family support. Developing interventions to support treatment-related decision making was the top research priority. Limitations Results reflect perceptions of about half of the clinicians at one academic health center. Conclusions Additional studies to capture patients' and families' perspectives and examine end-of-life care processes are needed. Results may inform future targeted interventions.