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Healthcare
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Supportive and Palliative Care in Renal Disease
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Supportive and Palliative Care in Renal Disease

A special issue of Healthcare (ISSN 2227-9032).

Deadline for manuscript submissions: closed (30 November 2015) | Viewed by 28212

Special Issue Editor

Prof. Dr. Helen Noble

E-Mail Website
Guest Editor
Medical Biology Centre, School of Nursing and Midwifery, Queen’s University, Belfast BT9 7BL, UK
Interests: mindfulness; well-being; quality of life; complimentary therapies; Palliative care; nephrology; qualitative
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

There is growing recognition of the importance of a supportive and palliative care strategy for people with advanced chronic kidney disease. This includes care through the course of renal replacement therapy and as people approach the end of their lives. Raising the quality of end of life care and recognising the individual needs of patients and their carers is critical to helping people live as well as possible until they die. It includes management of pain and other symptoms and delivery of psychological, social, spiritual and practical support. This special issue of Healthcare will include original theoretical or empirical work related to the care of people with renal disease who require a palliative and supportive strategy. Topics of interest include, but are not limited to: advance care planning, symptom management, models of nursing/medical care, nursing/medical interventions, literature reviews, research protocols and innovative methods. Previously unpublished articles that describe research in diverse populations are invited and welcome.

Dr. Helen Noble
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.


Keywords

  • palliative care
  • advanced chronic kidney disease
  • dialysis
  • supportive care
  • end of life care

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Published Papers (5 papers)

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Research

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195 KiB  
Article
Advance Care Planning among People Living with Dialysis
by Barbara A. Elliott and Charles E. Gessert
Healthcare 2016, 4(1), 17; https://doi.org/10.3390/healthcare4010017 - 3 Mar 2016
Cited by 7 | Viewed by 4508
Abstract
Purpose: Recent nephrology literature focuses on the need for discussions regarding advance care planning (ACP) for people living with dialysis (PWD). PWD and their family members’ attitudes toward ACP and other aspects of late-life decision making were assessed in this qualitative study. Methodology: [...] Read more.
Purpose: Recent nephrology literature focuses on the need for discussions regarding advance care planning (ACP) for people living with dialysis (PWD). PWD and their family members’ attitudes toward ACP and other aspects of late-life decision making were assessed in this qualitative study. Methodology: Thirty-one interviews were completed with 20 PWD over the age of 70 (mean dialysis 34 months) and 11 family members, related to life experiences, making medical decisions, and planning for the future. Interviews were recorded, transcribed and analyzed. Findings: Four themes regarding ACP emerged from this secondary analysis of the interviews: how completing ACP, advance directives (AD), and identifying an agent fit into PWD experiences; PWD understanding of their prognosis; what gives PWD lives meaning and worth; and PWD care preferences when their defined meaning and worth are not part of their experience. These PWD and family members revealed that ACP is ongoing and common among them. They did not seem to think their medical providers needed to be part of these discussions, since family members were well informed. Practical implications: These results suggest that if health care providers and institutions need AD forms completed, it will important to work with both PWD and their family members to assure personal wishes are documented and honored. Full article
(This article belongs to the Special Issue Supportive and Palliative Care in Renal Disease)
97 KiB  
Article
Home Palliative Care for Patients with Advanced Chronic Kidney Disease: Preliminary Results
by José L. Teruel, Lourdes Rexach, Victor Burguera, Antonio Gomis, Milagros Fernandez-Lucas, Maite Rivera, Alicia Diaz, Sergio Collazo and Fernando Liaño
Healthcare 2015, 3(4), 1064-1074; https://doi.org/10.3390/healthcare3041064 - 28 Oct 2015
Cited by 6 | Viewed by 4709
Abstract
Healthcare for patients with advanced chronic kidney disease (ACKD) on conservative treatment very often poses healthcare problems that are difficult to solve. At the end of 2011, we began a program based on the care and monitoring of these patients by Primary Care [...] Read more.
Healthcare for patients with advanced chronic kidney disease (ACKD) on conservative treatment very often poses healthcare problems that are difficult to solve. At the end of 2011, we began a program based on the care and monitoring of these patients by Primary Care Teams. ACKD patients who opted for conservative treatment were offered the chance to be cared for mainly at home by the Primary Care doctor and nurse, under the coordination of the Palliative Care Unit and the Nephrology Department. During 2012, 2013, and 2014, 76 patients received treatment in this program (mean age: 81 years; mean Charlson age-comorbidity index: 10, and mean glomerular filtration rate: 12.4 mL/min/1.73 m2). The median patient follow-up time (until death or until 31 December 2014) was 165 days. During this period, 51% of patients did not have to visit the hospital’s emergency department and 58% did not require hospitalization. Forty-eight of the 76 patients died after a median time of 135 days in the program; 24 (50%) died at home. Our experience indicates that with the support of the Palliative Care Unit and the Nephrology Department, ACKD patients who are not dialysis candidates may be monitored at home by Primary Care Teams. Full article
(This article belongs to the Special Issue Supportive and Palliative Care in Renal Disease)
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Review

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187 KiB  
Review
Symptom Management in Patients with Stage 5 CKD Opting for Conservative Management
by Sheila Johnston
Healthcare 2016, 4(4), 72; https://doi.org/10.3390/healthcare4040072 - 22 Sep 2016
Cited by 4 | Viewed by 6157
Abstract
Chronic kidney disease (CKD) stages 3–5 now affects 8.5% of adults in the United Kingdom; with 4% of patients expected to reach stage 5 CKD. Increasing numbers of older patients are contributing to the growth of demand of kidney services. With the exception [...] Read more.
Chronic kidney disease (CKD) stages 3–5 now affects 8.5% of adults in the United Kingdom; with 4% of patients expected to reach stage 5 CKD. Increasing numbers of older patients are contributing to the growth of demand of kidney services. With the exception of transplantation, dialysis has been the main form of renal replacement therapy (RRT) for advanced CKD. This elderly population is usually too frail and has many other co-existing medical complaints or co morbidities to undergo transplantation. Dialysis is an invasive treatment, and some frail elderly patients can experience many dialysis related symptoms. An alternative option for these patients is to choose conservative management (CM) of their stage 5 CKD. These patients often have complex supportive and palliative care needs. The frequency, severity and distress caused by symptoms related to stage 5 CKD are often under recognized and under treated. There is a need for early identification and management of symptoms as they present in patients with stage 5 CKD being managed conservatively. Symptom assessment should be focused on anticipating, identifying and alleviating any symptoms. This needs to be incorporated into the regular practice of those managing CM patients. Full article
(This article belongs to the Special Issue Supportive and Palliative Care in Renal Disease)
158 KiB  
Review
Spirituality in Renal Supportive Care: A Thematic Review
by Richard Egan, Sarah Wood, Rod MacLeod and Robert Walker
Healthcare 2015, 3(4), 1174-1193; https://doi.org/10.3390/healthcare3041174 - 16 Nov 2015
Cited by 7 | Viewed by 7023
Abstract
Chronic kidney disease is marked by a reduced life expectancy and a high symptom burden. For those who reach end-stage renal disease, the prognosis is poor, and this combined with the growing prevalence of the disease necessitates supportive and palliative care programmes that [...] Read more.
Chronic kidney disease is marked by a reduced life expectancy and a high symptom burden. For those who reach end-stage renal disease, the prognosis is poor, and this combined with the growing prevalence of the disease necessitates supportive and palliative care programmes that will address people’s psychosocial, cultural and spiritual needs. While there is variation between countries, research reveals that many renal specialist nurses and doctors are reluctant to address spirituality, initiate end-of-life conversations or implement conservative treatment plans early. Yet, other studies indicate that the provision of palliative care services, which includes the spiritual dimension, can reduce symptom burden, assist patients in making advanced directives/plans and improve health-related quality of life. This review brings together the current literature related to renal supportive care and spirituality under the following sections and themes. The introduction and background sections situate spirituality in both healthcare generally and chronic kidney disease. Gaps in the provision of chronic kidney disease spiritual care are then considered, followed by a discussion of the palliative care model related to chronic kidney disease and spirituality. Chronic kidney disease spiritual needs and care approaches are discussed with reference to advanced care planning, hope, grief and relationships. A particular focus on quality of life is developed, with spirituality named as a key dimension. Finally, further challenges, such as culture, training and limitations, are explicated. Full article
(This article belongs to the Special Issue Supportive and Palliative Care in Renal Disease)
96 KiB  
Review
Ageing Renal Patients: We Need More Collaboration between Geriatric Services and Nephrology Departments
by Helen Alston and Aine Burns
Healthcare 2015, 3(4), 1075-1085; https://doi.org/10.3390/healthcare3041075 - 30 Oct 2015
Cited by 4 | Viewed by 4621
Abstract
There has been a significant increase in the number of frail older patients diagnosed with advanced chronic kidney disease (CKD) over the past thirty years. These elderly patients have high levels of comorbidity, and as a consequence the face of renal medicine is [...] Read more.
There has been a significant increase in the number of frail older patients diagnosed with advanced chronic kidney disease (CKD) over the past thirty years. These elderly patients have high levels of comorbidity, and as a consequence the face of renal medicine is changing—There is an increasing need to focus on traditionally geriatric areas of expertise such as falls prevention and rehabilitation, and to shift our emphasis onto improving patient well-being rather than longevity. Over the past decade, many nephrologists have found that they are already acting as de facto “amateur geriatricians”. This denies patients both the benefits of specialist geriatric assessment, and equally importantly denies them access to the wider geriatric multidisciplinary team. This article describes the prevalence and underlying causes of the so-called “Geriatric Giants” in patients with advanced CKD, and discusses possible improvements in care that closer working with geriatricians could bring. Full article
(This article belongs to the Special Issue Supportive and Palliative Care in Renal Disease)
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