Advances in chronic kidney disease
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Adv Chronic Kidney Dis · Oct 2007
ReviewBegin with the end in mind: the value of outcome-driven nephrology social work.
The last decade has brought multiple changes in the delivery of care to patients with chronic kidney disease (CKD), and the nephrology social worker, like other members of the dialysis care team, has changed in response to a new health care climate. This article reviews a disease course perspective of CKD and the outcome-driven nephrology social work model of practice. The outcome-driven model is strategic and works toward improving patient outcomes. ⋯ Measurement is the key to refining interventions to meet patient and clinic needs. Once an intervention is fine tuned, it can become a standard intervention in a "tool kit" that can be used by the social worker on micro- and macrolevels. This model of nephrology social work practice can improve treatment outcomes in areas such as depression management, fluid management, care planning, missed treatments, rehabilitation, satisfaction with care, and reduced hospitalizations.
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Adv Chronic Kidney Dis · Oct 2007
ReviewPalliative care in end-stage renal disease: illness trajectories, communication, and hospice use.
Palliative care is comprehensive, interdisciplinary care focusing on pain and symptom management, advance-care planning and communication, psychosocial and spiritual support, and, in end-stage renal disease (ESRD), the ethical issues in dialysis decision making. End-of-life care is one aspect of palliative care and incorporates all of the previously mentioned components as well as hospice and bereavement care. ESRD patients and their families are appropriate candidates for palliative care because of their high symptom burden, shortened survival, and significant comorbidity. ⋯ Although communication is an integral component of palliative care, little is understood about effective provider-patient communication, especially in estimating and discussing prognosis. Palliative care has much to offer toward improving the quality of dialysis patients' lives as well as planning for and improving the quality of their deaths. The palliative care issues of illness trajectory, communication, and hospice use among ESRD patients will be reviewed.