透析中以患者为中心的预先护理计划：HIGHWay（尊重个人目标与希望之路）倡议。

Patient-Centered Advance Care Planning in Dialysis: The HIGHWay (Honor Individual Goals and Hopes Way) Initiative.

作者信息

Rodriguez de Sosa Giselle M, Thamer Mae, Anderson Elizabeth, Unruh Mark L, Lupu Dale E

机构信息

Department of Medicine, University of New Mexico, Albuquerque, New Mexico.

Medical Technology and Practice Patterns Institute, Bethesda, Maryland.

出版信息

Kidney360. 2025 Apr 25;6(6):957-967. doi: 10.34067/KID.0000000767.

DOI:10.34067/KID.0000000767

PMID:40279178

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12233858/

Abstract

KEY POINTS

Honoring Individuals Goals and Hopes Way: Implementing Advance Care Planning for Persons with Kidney Disease on Dialysis (HIGHWay) empowers dialysis social workers and nurses to lead advance care planning (ACP) discussions with patients as part of their workflow. HIGHWay uses motivational interviewing to overcome barriers in ACP, improve conversation quality, and help engage patients. HIGHWay demonstrated successful adoption, feasibility, and acceptability for ACP practices and outcomes despite barriers in patient readiness and time.

BACKGROUND

Patients on dialysis want to discuss their preferences for treatment. The Shared Decision-Making Renal Supportive Care intervention effectively elicited dialysis patient preferences for end-of-life care. The Honoring Individuals Goals and Hopes Way: Implementing Advance Care Planning for Persons with Kidney Disease on Dialysis (HIGHWay) project updated this intervention to scale it for broader implementation of advance care planning (ACP) to all patients during their regular dialysis sessions, no matter the severity of illness or time on dialysis, and to address previously found barriers.

METHODS

HIGHWay implemented ACP for dialysis patients of participating social workers and nurses, incorporating these conversations into the regular workflow. Participants completed a 6-hour online training course made by study investigators, focusing on motivational interviewing and person-centered approaches. They then received nine monthly group coaching sessions to strengthen their discussion skills. Data on participant engagement were collected by survey; preprogram, midpoint (6 months), postimplementation (9 months), and weekly surveys were conducted over the following 9 months to track conversations. The Consolidated Framework for Implementation Research framework was used to measure implementation outcomes.

RESULTS

We enrolled 55 social workers and nurses from three dialysis organizations from June 2021 to December 2023 across 61 dialysis clinics in the United States. After a 9-month follow-up period, 1526 conversations were conducted. Of these, 868 were newly initiated cases. Participants reported an average of 1.7 conversations per week, most 30 minutes or less. The mean feasibility on 12 ACP-related activities on a 5-point scale increased from 3.4 (SD=1.0) pretraining to 4.2 (SD=0.85) after 9 months of follow-up ( < 0.05). Notably, 65% of the respondents felt more skillful addressing patient reluctance and 60% reported being more at ease with ACP topics.

CONCLUSIONS

HIGHWay enhances confidence and skills in conducting ACP for patients undergoing chronic dialysis. High scores for acceptability, appropriateness, and sustainability suggest that HIGHWay is ready for widespread use across all US dialysis facilities.

CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER

: NCT05324878.

PODCAST

This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/K360/2025_06_26_KID0000000767.mp3

摘要

要点

尊重个人目标与希望途径：为透析肾病患者实施预先护理计划（HIGHWay）使透析社会工作者和护士有能力在其工作流程中与患者进行预先护理计划（ACP）讨论。HIGHWay运用动机性访谈来克服ACP中的障碍，提高对话质量，并帮助患者参与其中。尽管患者准备情况和时间存在障碍，但HIGHWay在ACP实践和结果方面展示了成功的采用、可行性和可接受性。

背景

透析患者希望讨论他们的治疗偏好。共享决策肾脏支持性护理干预有效地引出了透析患者对临终护理的偏好。尊重个人目标与希望途径：为透析肾病患者实施预先护理计划（HIGHWay）项目对这一干预进行了更新，以便将其扩展到在所有患者定期透析期间更广泛地实施预先护理计划（ACP），无论疾病严重程度或透析时间长短，并解决先前发现的障碍。

方法

HIGHWay为参与的社会工作者和护士的透析患者实施ACP，并将这些对话纳入常规工作流程。参与者完成了由研究调查人员制作的6小时在线培训课程，重点是动机性访谈和以患者为中心的方法。然后，他们接受了九个月的月度小组辅导课程，以加强他们的讨论技巧。通过调查收集参与者参与情况的数据；在接下来的9个月中进行了项目前、中点（6个月）、实施后（9个月）以及每周的调查，以跟踪对话。采用实施研究综合框架来衡量实施结果。

结果

从2021年6月至2023年12月，我们在美国61个透析诊所招募了来自三个透析机构的55名社会工作者和护士。经过9个月的随访期，共进行了1526次对话。其中，868次是新发起的案例。参与者报告平均每周进行1.7次对话，大多数对话时长为30分钟或更短。在5分制的12项与ACP相关活动的平均可行性从培训前的3.4（标准差 = 1.0）在随访9个月后提高到了4.2（标准差 = 0.85）（P < 0.05）。值得注意的是，65%的受访者感觉在应对患者的不情愿方面更有技巧，60%的受访者表示在ACP主题方面更自在。