#NephMadness 2023: Supportive Care for Kidney Failure for the Win

Posted on April 7, 2023 by AJKDblog in NephMadness // 0 Comments

Jane Schell @JaneSchell11

Jane Schell is Section Chief of Palliative Care at the University of Pittsburgh. She is an Associate Professor of Medicine and a practicing nephrology and palliative care physician. Dr. Schell is known for work in developing a nationally recognized communication training, NephroTalk, which teaches palliative care communication skills for nephrology clinicians. Her passion is creating education and innovative programs to improve the lives of people living with kidney disease across the disease continuum.

***Competitors for the* *Transitions of Care Region***

Team 1: Supportive Care for Kidney Failure vs Team 2: Pediatric to Adult Care

The good physician treats the disease; the great physician treats the [person] who has the disease. William Osler

Go Team Supportive Care for Kidney Failure Team! This year I am excited to throw my hat in the ring for this up-and-coming team. This team employs a different strategy to kidney care that gets to the heart of the matter – what matters most. This team thrives on care practices to achieve high-value person-centered care in kidney disease.

So, you may be thinking: What is Supportive Care? Why Supportive Care? How can I join this Team? Grab a water bottle and your gym shoes and let’s get started!

First – What is Supportive Care for Kidney Failure?
Supportive Care is about caring for the whole person no matter what stage of illness or what treatments a person is receiving. People living with kidney disease can access supportive care across the disease continuum – whether they are living with kidney disease, receiving dialysis or a transplant. Supportive care also known as palliative care aims to aggressively manage symptoms, engage in conversations about the things that matter most, and support positive coping for living with kidney disease.

Second – Why Supportive Care?
Supportive care aims to improve how people with kidney disease live. Supportive care aims to relieve distressing symptoms which many patients with CKD and those on dialysis experience. Another key component of supportive care is engaging in conversations about what matters most to guide treatment decisions for their kidney disease and the future. Patients and their families want to talk about their priorities and often report strong preferences for how they live especially if their health were to worsen. Yet data suggests nephrology clinicians have limited understanding of these priorities and are less comfortable in recommending treatments other than dialysis such as conservative kidney care. Similarly, in a recent study of dialysis patients, almost half indicated a preference for comfort-focused care in a poor health state; yet, most had not engaged in advance care planning or discussions about end-of-life preferences.

Better conversations about what matters most will promote treatment decisions that align with patient values and priorities. Conservative kidney care or active non-dialytic management of kidney disease is a patient-centered treatment option for those who prefer to focus on maximizing quality of life, particularly those who may not derive the hoped-for benefits of dialysis. Outcomes show that patients receiving conservative kidney care can live months to several years and maintain a relatively stable quality of life until late in the illness course. Data from both the US and Australia demonstrate that conservative kidney care can lead to better symptom management, decreased hospitalization, and improved access to quality end-of-life care.

Third – How can you join the Supportive Care Team?
Any nephrology clinician can join the Supportive Care Team. There is no special training or membership dues. It requires only that your playbook puts the patient at the center of care. It only requires that your playbook puts the patient at the center of care, as described in Ann O’Hare’s article to promote kidney care that is person-centered. Other tools exist for clinicians to cultivate supportive care skills including conservative kidney care.

On behalf of the Supportive Care for Kidney Failure Team, I challenge you to start training today – Pull up a chair and ask a patient ‘What matters most to you?”

– Guest Post written by Jane Schell @JaneSchell11

As with all content on the AJKD Blog, the opinions expressed are those of the author of each post, and are not necessarily shared or endorsed by the AJKD Blog, AJKD, the National Kidney Foundation, Elsevier, or any other entity unless explicitly stated.

Click to read the Transitions of Care Region