Enablers and Barriers to Integrating Advance Care Planning in Chronic Kidney Disease Care in a Canadian Provincial Network.

Background: Individuals with advanced chronic kidney disease benefit from an integrated palliative approach to care through timely advance care planning and discussions about their goals of care. Despite literature and guidelines emphasizing the need for advance care planning in chronic kidney disease management, treatment-focused approach remains the norm, partly due to provider reluctance and discomfort in engaging in advance care planning conversations. In British Columbia (BC), the Integrated Palliative Nephrology (IPN) project was launched to enhance kidney health care provider engagement in advance care planning and goals of care discussions, to train kidney health care providers in the province to initiate serious illness conversations, and to develop standardized resources for patients and providers across a provincial renal network. Objective: As part of the quality improvement, this study highlights the barriers/challenges and enablers to engage in advance care planning for health care providers of adult patients with chronic kidney disease. Design: A multi-methods approach was used. Setting: British Columbia, Canada. Participants: Kidney health care providers who worked in nondialysis and dialysis care settings. Methods: Data were collected through semistructured surveys, individual interviews, and focus groups with health care providers across the province who care for patients with chronic kidney disease. Results: The results of a kidney health care provider survey (n = 90) showed self-reported improvements in knowledge of the integrated palliative approach and competency and comfort engaging in advance care planning discussions. The results of one-on-one interviews (n = 15) and focus groups (n = 32) with kidney health care providers showed that taking a relational approach with patients, enhancing provider comfort and competency with advance care planning, clarifying roles and responsibilities around who should engage in advance care planning conversation was beneficial to patient care. Supporting cohesion among care teams around the goal of advancing an integrated palliative approach, and offering mentorship and targeted education and resources for the kidney care team, can enable effective advance care planning discussions. Limitations: The study was limited by purposive sampling, a small sample size, and potential bias due to participant interests and settings. Conclusions: For kidney health care providers, targeted education and resources, clarity around roles and responsibilities, and long-term relationships with patients may help advance the cultural shift from treatment focus to integrating palliative care across the continuum of the illness journey. Trial registration: Not registered.