REVIEW OF PATIENT INVOLVEMENT IN KIDNEY TRANSPLANT OFFERS: AN OPPORTUNITY FOR SHARED DECISION MAKING?

A WEIGHTMAN1,2,  P CLAYTON1,2,3,  S COGHLAN4

1University Of Adelaide, Adelaide, Australia, 2Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia, 3Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia, 4University of Melbourne, Melbourne, Australia

Background: Renal supportive care (RSC) is a multidisciplinary patient-centred model of care that aims to improve quality of life in patients with chronic kidney disease (CKD). The Integrated Palliative Outcome Score (IPOS)-renal survey is a validated tool to assess symptoms in this population.
Aim: To examine the effect of RSC on symptom control, assess progression of symptom burden in advanced CKD, and determine potential gaps in the current model of care.
Method: IPOS-renal scores were collected for all patients attending the ISLHD RSC service between November 2015 and July 2019. Patients were categorised as symptomatic or asymptomatic at the initial clinic visit. Changes in individual and summative scores were stratified by time (0-6 months, >6-12 months, and >12 months) and analysed using paired T-test.
Results: 245 patients were referred to RSC, of whom 60 completed two or more IPOS-renal surveys. 31 (52%) were female and 29 (48%) were male. The median [IQR] age was 80 [72-85], eGFR was 13 [7-16] ml/min/1.73m2 and Karnofsky score was 70 [60-80]. Weakness (n=59, 97%) and poor mobility (n=52, 85%) were the most common initial complaints. Poor mobility was the only symptom that deteriorated between 0-6 months. The greatest improvement was seen in dyspnoea, particularly in the first six months (p<0.001). More than 50% of asymptomatic patients remained symptom free for over 12 months. The most common new-onset symptoms were nausea, dyspnoea and drowsiness between 0-6 months, and pruritus, dry mouth, and constipation after 12 months.
Conclusions: RSC provides effective symptom control particularly in dyspnoea for patients with advanced CKD. Gaps remain in the current model of care, including management of poor mobility. Incorporating physiotherapy may provide further support.


Biography:
Dr Alison Weightman is a South Australian nephrologist with an interest in Bioethics and Kidney Transplantation. She is based at SAHMRI but also works part time at Flinders Medical Centre. She has recently commenced her PhD on Decision-Making in Transplantation where she will be combining ethical analysis with qualitative methodologies.

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