Naik Bharathi, Ghoshal Arun, Damani Anuja, Singhai Pankaj, Prabhu Attur Ravindra, Salins Naveen, Nayak Ajith M, Nagaraju Shankar Prasad
Department of Renal Replacement Therapy and Dialysis Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.
Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
Nephron. 2025;149(1):48-56. doi: 10.1159/000541347. Epub 2024 Sep 9.
Advance care planning (ACP) is essential in managing patients with end-stage kidney disease (ESKD), yet its integration into clinical practice remains limited, particularly in low- and middle-income countries. This study explores the preferences, attitudes and perceived barriers of nephrology healthcare providers toward ACP for patients with ESKD in a tertiary care center in India.
A cross-sectional survey was conducted among nephrology healthcare providers at a tertiary care center in India. The survey, developed from literature reviews and pretested, covered demographics, ACP knowledge and attitudes, current practices, and perceived barriers and facilitators. Data collection occurred from September 2022 to March 2023. Quantitative data were analyzed descriptively, and qualitative data through thematic analysis.
A total of 50 healthcare providers participated. While 36% acknowledged the importance of ACP, only 8% routinely engaged in ACP discussions. Major barriers included inadequate training (22%), lack of awareness about the importance of discussing ACP among stakeholders (20%), cultural barriers (18%), lack of time (14%), and the absence of institutional protocols for discussion on ACP (14%). Additional barriers included instances where families withhold health information from patients due to fear of losing hope (16%) and patient/family discomfort in discussing ACP (12%). Providers expressed a need for structured ACP protocols and educational programs.
Despite recognizing its importance, ACP is underutilized in the care of patients with ESKD in India. Addressing the identified barriers through targeted interventions may enhance ACP practices and improve patient outcomes.
预先护理计划（ACP）对于终末期肾病（ESKD）患者的管理至关重要，但其在临床实践中的整合程度仍然有限，尤其是在低收入和中等收入国家。本研究探讨了印度一家三级医疗中心的肾脏病医疗服务提供者对ESKD患者进行ACP的偏好、态度和感知障碍。
在印度一家三级医疗中心对肾脏病医疗服务提供者进行了横断面调查。该调查基于文献综述制定并经过预测试，涵盖人口统计学、ACP知识和态度、当前实践以及感知障碍和促进因素。数据收集于2022年9月至2023年3月进行。定量数据进行描述性分析，定性数据通过主题分析进行分析。
共有50名医疗服务提供者参与。虽然36%的人承认ACP的重要性，但只有8%的人经常进行ACP讨论。主要障碍包括培训不足（22%）、利益相关者对讨论ACP重要性的认识不足（20%）、文化障碍（18%）、时间不足（14%）以及缺乏关于ACP讨论的机构协议（14%）。其他障碍包括因担心失去希望而家人向患者隐瞒健康信息的情况（16%）以及患者/家属在讨论ACP时感到不适（12%）。提供者表示需要结构化的ACP协议和教育项目。
尽管认识到其重要性，但ACP在印度ESKD患者的护理中未得到充分利用。通过有针对性的干预措施解决已确定的障碍可能会加强ACP实践并改善患者结局。
