ArticleAmerican journal of kidney diseases : the official journal of the National Kidney Foundation2016
Nephrologist-Facilitated Advance Care Planning for Hemodialysis Patients: A Quality Improvement Project.
Article in American journal of kidney diseases : the official journal of the National Kidney Foundation, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 20 papers, 5 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
20 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- The Surprise Question and clinician-predicted prognosis: systematic review and meta-analysis.BMJ supportive & palliative care · 2024Pooled it
- The utility of the surprise question: A useful tool for identifying patients nearing the last phase of life? A systematic review and meta-analysis.Palliative medicine · 2022Pooled it
- Improving Care Experiences for Patients and Caregivers at End of Life: A Systematic Review.The American journal of hospice & palliative care · 2021Pooled it
- How accurate is the 'Surprise Question' at identifying patients at the end of life? A systematic review and meta-analysis.BMC medicine · 2017Pooled it
- The "surprise question" for predicting death in seriously ill patients: a systematic review and meta-analysis.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2017Pooled it
- Navigating patients' refusal of information in clinical practice - a clinical scenario.Medicine, health care, and philosophy · 2026Article
- Charlson comorbidity index and all-cause mortality in patients with delayed hemodialysis initiation: a prospective cohort study.BMC nephrology · 2025Article
- The development and feasibility study of Multidisciplinary Timely Undertaken Advance Care Planning conversations at the outpatient clinic: the MUTUAL intervention.BMC palliative care · 2022Article
- Using the "Surprise Question" to Predict Frailty and Healthcare Outcomes among Older Adults Attending the Emergency Department.International journal of environmental research and public health · 2022Article
- Barriers to Conservative Management Conversations: Perceptions of Nephrologists and Fellows-in-Training.Journal of palliative medicine · 2021Article
- Cardiopulmonary Resuscitation Preferences of People Receiving Dialysis.JAMA network open · 2020Article
- Nonhospice Palliative Care Within the Treatment of End-Stage Liver Disease.Hepatology (Baltimore, Md.) · 2020Review
- Supporting quality care for ESRD patients: the social worker can help address barriers to advance care planning.BMC nephrology · 2020Article
- Advance care planning with patients on hemodialysis: an implementation study.BMC palliative care · 2019Article
- Facility Variation and Predictors of Do Not Resuscitate Orders of Hemodialysis Patients in Canada: DOPPS.Canadian journal of kidney health and disease · 2019Article
- "End-of-Life Care? I'm not Going to Worry About That Yet." Health Literacy Gaps and End-of-Life Planning Among Elderly Dialysis Patients.The Gerontologist · 2018Article
- The "Surprise Question" in Neurorehabilitation-Prognosis Estimation by Neurologist and Palliative Care Physician; a Longitudinal, Prospective, Observational Study.Frontiers in neurology · 2018Article
- Reliability and Utility of the Surprise Question in CKD Stages 4 to 5.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2017Observational
- Research Priorities for Palliative Care for Older Adults with Advanced Chronic Kidney Disease.Journal of palliative medicine · 2017Article
- Palliative care for patients with end-stage renal disease: approach to treatment that aims to improve quality of life and relieve suffering for patients (and families) with chronic illnesses.Clinical kidney journal · 2017Article
Corrections and comments
- Commented on by
- Erratum issued
Authors and funding
5 authors.
Funding
Abstract
backgroundThe Renal Physicians Association's clinical practice guideline recommends that physicians address advance care planning with dialysis patients. However, data are lacking about how best to implement this recommendation. STUDY
designQuality improvement project. SETTINGS &
participantsNephrologists caring for patients treated with maintenance hemodialysis at 2 dialysis facilities identified patients who might benefit most from advance care planning using the "surprise" question ("Would I be surprised if this patient died in the next year?"). QUALITY IMPROVEMENT PLAN: Patients identified with a "no" response to the surprise question were invited to participate in nephrologist-facilitated advance care planning, including completion of a Medical Orders for Life-Sustaining Treatment (MOLST) form. OUTCOMES: Change in MOLST completion rate and identification of preferences for limits on life-sustaining treatment. MEASUREMENTS: Pre- and postintervention code status, MOLST completion rate, and vital status at 1 year.
resultsNephrologists answered "no" to the surprise question for 50 of 201 (25%) hemodialysis patients. Of these, 41 (82%) patients had a full-code status and 9 (18%) had a do-not-resuscitate (DNR) status. Encounters lasted 15 to 60 minutes. Following the encounter, 21 (42%) patients expressed preference for a DNR status and 29 (58%) maintained full-code status (P=0.001). The MOLST completion rate increased from 10% to 90%. One-year survival for patients whose nephrologists answered "no" to the surprise question was 58% compared to 92% for those with a "yes" answer (P<0.001). LIMITATIONS: Sample size and possible nonrepresentative dialysis population.
conclusionsNephrologist-facilitated advance care planning targeting hemodialysis patients with limited life expectancy led to significant changes in documented patient preferences for cardiopulmonary resuscitation and limits on life-sustaining treatment. These changes demonstrate the benefit of advance care planning with dialysis patients and likely reflect better understanding of end-of-life treatment options.
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