Seminars in dialysis
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Seminars in dialysis · Mar 2005
ReviewPalliative care in end-stage renal disease: focus on advance care planning, hospice referral, and bereavement.
The components of palliative care in end-stage renal disease (ESRD) include pain and symptom management, advance care planning, psychosocial and spiritual support, and ethical issues in dialysis. End-of-life care is not synonymous with, but rather a subset of palliative care. ⋯ It is incumbent upon dialysis care providers to include advance care planning in overall care plans for their patients. Factors contributing to the failure of advance care planning in ESRD patients will be discussed, as will hospice and ESRD, and opportunities for bereavement programs.
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Seminars in dialysis · Mar 2005
ReviewHealth-related quality of life in nephrology research and clinical practice.
Physical, psychosocial, and lifestyle disturbances, along with physical and emotional symptoms, have been shown to impact the health-related quality of life (HRQOL) of those dependent on renal replacement therapy. The value of HRQOL measurement as a tool to improve clinical care has been recognized by patients, clinical investigators, and health care providers. The potential importance of HRQOL assessment lies in the additional information it provides and the impact it has on the clinical decision-making process between a patient and a physician. ⋯ Arguably, optimizing HRQOL may be the most substantial impact the health care team will have on the person with kidney failure. In order to implement HRQOL assessment at the point of care, providers may consider using computer adaptive testing and scoring algorithms using item response theory, which will allow adequate reliability for interpretation of change among individuals. Moreover, the effective assessment and interpretation of HRQOL will be aided by continued publication of norms, outcomes of randomized controlled trials, and continued experience of investigators and clinicians.