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Session 3: Concurrent 1.2
Concurrent Session
Concurrent Session
1:45 pm
13 June 2024
Plaza Auditorium
Session Description
Session Chair: Jo Jones
Session Program
428R - Research Paper
Abstract:
Aim:
To assess rates of documented ACP in CKD populations.
Method:
A systematic review of English language studies published between January 2011 and December 2023 retrieved from Medline, PubMed and Cumulative Index to Nursing and Allied Health Literature databases. Inclusion criteria were adults with CKD and reporting ACP (including directives, enduring power of attorney). Two review authors identified studies for full review, data extraction and quality assessment. Data synthesis and quality assessment followed the Joanna Briggs Institute quality appraisal checklist.
Results:
Twenty-one studies met the inclusion criteria with n= 305,033 participants. Three studies were randomised control trials, 14 cross-sectional and the remaining 4 were either case-control or qualitative descriptive designs. Rates of documented ACP ranged from 5% to 89% (median 37%). Challenges to completing ACPs were length of time to complete, clinician role ambiguity and lack of reimbursement attached to the ACP process.
Conclusion:
Documented ACP rates for patients with CKD are suboptimal. This is a significant gap in current care of people with CKD, with understanding current rates and challenges associated, an important first step to improvement.
Abstract:
Aim:
To assess rates of documented ACP in CKD populations.
Method:
A systematic review of English language studies published between January 2011 and December 2023 retrieved from Medline, PubMed and Cumulative Index to Nursing and Allied Health Literature databases. Inclusion criteria were adults with CKD and reporting ACP (including directives, enduring power of attorney). Two review authors identified studies for full review, data extraction and quality assessment. Data synthesis and quality assessment followed the Joanna Briggs Institute quality appraisal checklist.
Results:
Twenty-one studies met the inclusion criteria with n= 305,033 participants. Three studies were randomised control trials, 14 cross-sectional and the remaining 4 were either case-control or qualitative descriptive designs. Rates of documented ACP ranged from 5% to 89% (median 37%). Challenges to completing ACPs were length of time to complete, clinician role ambiguity and lack of reimbursement attached to the ACP process.
Conclusion:
Documented ACP rates for patients with CKD are suboptimal. This is a significant gap in current care of people with CKD, with understanding current rates and challenges associated, an important first step to improvement.
416R - Research Paper
Abstract
Aim:
To improve access to KSC care for people with advanced kidney failure who are unable to attend outpatient clinics due to frailty.
Method:
During the period October 2023-April 2024, data on demographic profile, number and frequency of appointments, Charlson Comorbidity Index (CCI), Clinical Frailty Scale (CFS); symptom experience and management (IPOS-Renal); health-related quality of life (EQ5D5L); patient/carer satisfaction and completed advance care planning were extracted from REDCap data management system.
Results:
Sixteen patients received a home visit, on average, every 3 months, (average age 81; range 67-91 years). Average clinician-reported scores were 7 for CCI and 6 for CFS, while average patient-reported scores were 10 for IPOS-Renal and 50 for EQ5D5L. Patient/carer satisfaction was high and 100% of visited patients have documented some form of ACP. All the patients who have met the home visiting criteria have agreed to the initial and ongoing NP visits.
Conclusion:
The NP led home visiting KSC service allows access to care that, until now, was beyond reach for those who were unable to attend clinic appointments due to frailty. Evaluation of the home visiting service is ongoing and will be reported on at 6 months.
Abstract
Aim:
To improve access to KSC care for people with advanced kidney failure who are unable to attend outpatient clinics due to frailty.
Method:
During the period October 2023-April 2024, data on demographic profile, number and frequency of appointments, Charlson Comorbidity Index (CCI), Clinical Frailty Scale (CFS); symptom experience and management (IPOS-Renal); health-related quality of life (EQ5D5L); patient/carer satisfaction and completed advance care planning were extracted from REDCap data management system.
Results:
Sixteen patients received a home visit, on average, every 3 months, (average age 81; range 67-91 years). Average clinician-reported scores were 7 for CCI and 6 for CFS, while average patient-reported scores were 10 for IPOS-Renal and 50 for EQ5D5L. Patient/carer satisfaction was high and 100% of visited patients have documented some form of ACP. All the patients who have met the home visiting criteria have agreed to the initial and ongoing NP visits.
Conclusion:
The NP led home visiting KSC service allows access to care that, until now, was beyond reach for those who were unable to attend clinic appointments due to frailty. Evaluation of the home visiting service is ongoing and will be reported on at 6 months.
2:15 pm
437Q - Research Paper
Abstract
Aim:
The project aimed to co-design a clinical tool to improve the way in which consumers receive health care information and advice in KSC.
Method:
The QI change cycle was structured using a Knowledge-to-Action (KA) framework. A co-design approach, using interviews and focus groups, aimed to incorporate the lived experiences of consumers into designing a consumer-centred solution. Consumer surveys, project reports, staff consultation and administrative data was used to evaluate the QI implementation (fidelity, appropriateness and adoption) and outcome measures (effectiveness and satisfaction).
Results:
6 consumers (5 patients, 1 carer), including 2 First Nations people, co-designed a clinical template to record symptoms, treatments and plans, naming it an Appointment Summary. Consultation with front-line clinicians ensured clinical appropriateness. It has been adopted in 4 (N=6) MN KSC clinics. Preliminary feedback indicates positive rates of patient and staff satisfaction and effectiveness.
Conclusion:
This QI project has successfully co-designed and implemented a template for providing an individualised appointment summary for people attending a KSC clinic. Further research into the impact on patient care and clinical outcomes is required.
Abstract
Aim:
The project aimed to co-design a clinical tool to improve the way in which consumers receive health care information and advice in KSC.
Method:
The QI change cycle was structured using a Knowledge-to-Action (KA) framework. A co-design approach, using interviews and focus groups, aimed to incorporate the lived experiences of consumers into designing a consumer-centred solution. Consumer surveys, project reports, staff consultation and administrative data was used to evaluate the QI implementation (fidelity, appropriateness and adoption) and outcome measures (effectiveness and satisfaction).
Results:
6 consumers (5 patients, 1 carer), including 2 First Nations people, co-designed a clinical template to record symptoms, treatments and plans, naming it an Appointment Summary. Consultation with front-line clinicians ensured clinical appropriateness. It has been adopted in 4 (N=6) MN KSC clinics. Preliminary feedback indicates positive rates of patient and staff satisfaction and effectiveness.
Conclusion:
This QI project has successfully co-designed and implemented a template for providing an individualised appointment summary for people attending a KSC clinic. Further research into the impact on patient care and clinical outcomes is required.
421R - Research Paper
Abstract:
Aim:
To understand the characteristics of working aged adults with advanced CKD referred for KSC.
Method:
Using a cross-sectional design, adults (18-64 years) with advanced CKD referred between February 2016 and July 2021 were included. Data extracted from hospital records were demographic, clinical, symptoms (Integrated Palliative Care Outcome Scale Renal [IPOS-Renal]), health-related quality of life (HRQoL; European quality of life [EQ-5D-5L]), and advance care plan (ACP) completion.
Results:
Of 856 people referred during the study period, 156 (18%) were working aged adults (median age 57 years) with 69% receiving kidney replacement therapy. The majority were referred for symptom management (53%). The most prevalent symptoms were weakness (92%), poor mobility (83%), and pain (82%). Those on dialysis had significantly higher symptom scores than those not receiving dialysis (p<0.05).In terms of HRQoL, more than 90% reported problems with mobility and pain, and 11.7% reported that they were unable to conduct usual activities. Completion of an ACP was low (29%).
Conclusion:
Regular monitoring and early identification of symptoms in all patients with advanced CKD—regardless of age and whether on dialysis or not—is necessary. An ACP should not be considered only for older people, and that leaving ACP discussion to a later time may cause rushed and late decision-making that is detrimental to wellbeing.
Abstract:
Aim:
To understand the characteristics of working aged adults with advanced CKD referred for KSC.
Method:
Using a cross-sectional design, adults (18-64 years) with advanced CKD referred between February 2016 and July 2021 were included. Data extracted from hospital records were demographic, clinical, symptoms (Integrated Palliative Care Outcome Scale Renal [IPOS-Renal]), health-related quality of life (HRQoL; European quality of life [EQ-5D-5L]), and advance care plan (ACP) completion.
Results:
Of 856 people referred during the study period, 156 (18%) were working aged adults (median age 57 years) with 69% receiving kidney replacement therapy. The majority were referred for symptom management (53%). The most prevalent symptoms were weakness (92%), poor mobility (83%), and pain (82%). Those on dialysis had significantly higher symptom scores than those not receiving dialysis (p<0.05).In terms of HRQoL, more than 90% reported problems with mobility and pain, and 11.7% reported that they were unable to conduct usual activities. Completion of an ACP was low (29%).
Conclusion:
Regular monitoring and early identification of symptoms in all patients with advanced CKD—regardless of age and whether on dialysis or not—is necessary. An ACP should not be considered only for older people, and that leaving ACP discussion to a later time may cause rushed and late decision-making that is detrimental to wellbeing.
An overview of withdrawal from dialysis and the role of kidney supportive care.