Ducharlet Kathryn, Weil Jennifer, Gock Hilton, Philip Jennifer
Department of Palliative Medicine, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
Department of Nephrology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
Kidney Int Rep. 2023 Jun 8;8(8):1627-1637. doi: 10.1016/j.ekir.2023.04.031. eCollection 2023 Aug.
End-of-life care is an essential part of integrated kidney care. However, renal clinicians' experiences of care provision and perceptions of end-of-life care needs are limited. This study explored renal clinicians' experiences of providing end-of-life care and developed recommendations to improve experiences.
An exploratory qualitative study using semistructured focus groups and 1 interview was undertaken at 5 kidney services in Victoria, Australia. The transcripts were analyzed thematically.
Between February and December 2017, 54 renal clinicians (21 doctors and 33 nurses) participated in the study. Clinicians reported multiple challenges of end-of-life care experiences resulting in compromised treatment planning and decision making and highlighted priorities to guide better care experiences. Challenges of providing end-of-life care were underpinned by mismatches in illness and treatment expectations, limited engagement in advance care planning, medical complexity, and differences between clinicians and patients in what constituted quality of life. These challenges were associated with compromised end-of-life care planning, which resulted in care experiences that were rushed with a prolonged treatment focus, risking limited preparation for death and moral distress. Clinicians aspired for positive end-of-life care experiences, including patient control and consensus in decision making, and a coordinated and collaborative approach across healthcare providers.
Renal clinicians highlighted multiple factors and circumstances which resulted in experiences of compromised end-of-life care for patients with kidney disease. To improve care experiences, clinician-directed priorities included more training and support to facilitate systematic and earlier discussions about illness expectations and end-of-life care planning and greater communication and collaboration across healthcare providers is required.
临终关怀是综合肾脏护理的重要组成部分。然而，肾脏科临床医生在提供护理方面的经验以及对临终关怀需求的认知有限。本研究探讨了肾脏科临床医生提供临终关怀的经验，并提出了改善经验的建议。
在澳大利亚维多利亚州的5个肾脏服务机构进行了一项探索性定性研究，采用半结构化焦点小组和1次访谈。对转录本进行了主题分析。
2017年2月至12月期间，54名肾脏科临床医生（21名医生和33名护士）参与了该研究。临床医生报告了临终关怀经历中的多重挑战，这些挑战导致治疗计划和决策受到影响，并强调了指导更好护理体验的优先事项。提供临终关怀的挑战源于疾病与治疗期望的不匹配、预先护理计划参与度有限、医疗复杂性以及临床医生与患者在生活质量构成方面的差异。这些挑战与临终关怀计划的不完善有关，导致护理体验匆忙，以延长治疗为重点，存在死亡准备不足和道德困扰的风险。临床医生期望有积极的临终关怀体验，包括患者的控制权和决策共识，以及医疗服务提供者之间的协调与协作方法。
肾脏科临床医生强调了多种因素和情况，这些因素和情况导致了肾病患者临终关怀体验的不足。为了改善护理体验，临床医生主导的优先事项包括更多的培训和支持，以促进关于疾病期望和临终关怀计划的系统和早期讨论，并且需要医疗服务提供者之间加强沟通与协作。
