Advance Care Planning for Adults With CKD: A Systematic Integrative Review
Loading...
Date
2014-05
Authors
Luckett, T
Sellars, M
Tieman, Jennifer
Pollock, CA
Silvester, W
Butow, Phyllis N
Detering, KM
Brennan, Frank
Clayton, Josephine M
Journal Title
Journal ISSN
Volume Title
Publisher
Elsevier
Rights
© 2014 by the National Kidney Foundation, Inc.
Rights Holder
The National Kidney Foundation, Inc.
Abstract
Background
Recent clinical practice guidelines have highlighted the importance of advance care planning (ACP) for improving end-of-life care for people with chronic kidney disease (CKD).
Study Design
We conducted a systematic integrative review of the literature to inform future ACP practice and research in CKD, searching electronic databases in April 2013. Synthesis used narrative methods.
Setting & Population
We focused on adults with a primary diagnosis of CKD in any setting.
Selection Criteria for Studies
We included studies of any design, quantitative or qualitative..
Interventions
ACP was defined as any formal means taken to ensure health professionals and family members are aware of patients’ wishes for care in the event they become too unwell to speak for themselves.
Outcomes
Measures of all kinds were considered to be of interest.
Results
Fifty-five articles met criteria reporting on 51 discrete samples. All patient samples included people with Stage 5 CKD; two also included patients with Stage 4. Seven interventions were tested; all were narrowly focused and none was evaluated by comparing wishes for end-of-life care with care received. One intervention demonstrated effects on patient/family outcomes in the form of improved wellbeing and anxiety following sessions with a peer mentor. Insights from qualitative studies that have not been emphasised in interventions include the importance of instilling patient confidence that their advance directives will be enacted and discussing decisions about (dis)continuing dialysis separately from ‘aggressive’ life-sustaining treatments (e.g. ventilation).
Limitations
Whilst quantitative and qualitative findings were integrated according to best practice, methods for this are in their infancy.
Conclusions
Research on ACP in patients with CKD is limited, especially regarding intervention studies. Interventions in CKD should attend to barriers and facilitators at the levels of patient, caregiver, health professional and system. Intervention studies should measure impact on compliance with patient wishes for end-of-life care.
Index words
Chronic kidney disease, Renal failure, Advance care planning, Advance directives, Decision-making
Description
Author version made avilable in accordance with the publisher's policy.
© 2014, the National Kindney Foundation, inc.
Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
http://creativecommons.org/licenses/by-nc-nd/4.0/
Keywords
Citation
Luckett, T., Sellars, M., Tieman, J.J., Pollock, C., Silvester, W., Butow, P., et al. (2014). Advance care planning for adults with CKD: a systematic integrative review. American Journal of Kidney Diseases,63(5) pp. 761-770.