The End of the Shift: The Decision to Forego Dialysis and its Ethical Issues.

1. To identify patients with advanced CKD who need early Palliative Care referrals. 2. To review the ethical pillars of medicine and how they relate to providing Palliative Care for patients with advanced CKD. This talk discusses WHO are the patients with advanced CKD that are at risk for poor outcomes and need early Palliative Care, WHAT to discuss with these patients during family meetings, HOW to take care of patients opting for non-dialytic care, and WHY there are barriers to integrating Palliative Care in the management of patients with advanced CKD. The option to forego dialytic therapy is an important life event – but studies have shown that up to 95% of patients with advanced chronic kidney disease (CKD) have not had the opportunity to discuss conservative management with their providers. This is reflected in the very low rate of patients enrolled in hospice care with end stage kidney disease (ESKD) as their primary diagnosis. Throughout years of research, multiple barriers have been found, rooted in current kidney care practice, that preclude the delivery of Palliative Care to this vulnerable population. This talk is designed to provide learners of all levels the tools to address these barriers to end-of-life care for patients with CKD, while providing empiric evidence on how to overcome them. Furthermore, the talk elevates the topic by navigating through the challenges and questions raised by modern medical ethics in this setting of rapidly-evolving norms and values. The subject is organized into: WHO: Identifying "who" among patients with CKD are most at-risk for poor outcomes and who may benefit from Palliative Care WHAT: Reviewing "what" to discuss with patients and loved ones, using effective communication skills, when broaching conservative management of ESKD HOW: Outlining "how" to care for patients with ESKD opting for non-dialytic management with appropriate pharmacologic and non-pharmacologic interventions to alleviate their symptom burden WHY: Recognizing "why" foregoing dialysis raises difficult ethical questions that often cause distress and conflict among providers, patients and even loved ones There is a growing need for incorporating Palliative Care in the practice of Nephrology. While dialysis has been the mainstay of advanced CKD management, with what we have learned especially during the COVID pandemic, it is time we all step up to provide Palliative Care for this truly underserved and vulnerable population. Ethical / Legal Aspects of Care / Models of Palliative Care Delivery [ABSTRACT FROM AUTHOR]