Embedding Palliative Care (PC) in Nephrology Clinic: The Role of PC in Patients with Advanced Chronic Kidney Disease.

1. Examine a collaborative approach for developing criteria for nephrologists to consider referring patients with advanced CKD to palliative care, exploring the potential role of race in this process. 2. Describe the PC needs of patients with advanced CKD, by recalling the content of palliative care visits with patients with advanced CKD. A pilot study embedding palliative care (PC) into nephrology disproportionately engaged patients of diverse racial backgrounds with advanced CKD in decision-making around dialysis and addressed symptoms. This collaborative approach to PC delivery may help identify the cultural needs of a community and assist with better informed advance care planning. Under 10% of patients on dialysis discuss goals and values with their nephrologist (N), although nearly 90% want this conversation. Patients with advanced chronic kidney disease (CKD) have substantial symptom burden and face a high-stakes medical decision, yet rarely have palliative care (PC) involvement. In this pilot of integrating PC into Nephrology (N) clinic, we describe the process of identifying CKD patients with PC needs and the content of PC visits. N and PC clinicians collaboratively determined criteria for PC: 1) age >70, CKD 5; 2) age >70, CKD 4 and diabetes or cardiac disease; 3) age >80 and CKD 4 or 5. N received weekly emails with names of eligible patients. If referred, PC saw patients in N clinic before or after the N team, following them later in PC clinic as needed. Of 1143 patients screened, 129 (11.2%) met PC criteria, 42 (32.6%) were referred and 18 (14.0%) were seen by PC. Characteristics of patients seen by PC include: 72.2% female; 66.7% Asian, 33.3% Black; 50% married; average age 82.8 years (71 to 92); 66.7% non-English speaking. During first visits, PC addressed: 100% advance care planning, 77.8% symptoms, 72.2% dialysis with 69.2% expressing preferences to decline dialysis. During the pilot and 6 months following, patients saw PC 2.4 times (1 to 5); 38.9% admitted to hospital; 5.6% in ICU; none died. PC successfully integrated into a N clinic, engaging a racially diverse sample of patients with advanced CKD. Coordinating care between N and PC allowed patients to discuss treatment options, such as dialysis, and to address symptoms. This pilot included an unexpectedly racially diverse sample with no white patients, which the authors intend to explore further. Models of Palliative Care Delivery / Shared Decision Making / Advance Care Planning [ABSTRACT FROM AUTHOR]