End-of-Life Care for People with Kidney Failure Lacking in US, Study Finds

End-of-Life Care for People with Kidney Failure Lacking in US, Study Finds

End-of-life care traditionally has focused on patients with cancer and, increasingly, on those with dementia. But high-quality end-of-life care is also of prime importance to people with lung, kidney, or heart failure. A recent study of family-reported end-of-life care at veterans’ centers in the U.S., however, found that such care was markedly better for dementia or cancer patients than for those with these other diseases.

Study results were recently presented at AcademyHealth’s Annual Research Meeting, and published in JAMA Internal Medicine in the article, “Quality of End-of-Life Care Provided to Patients With Different Serious Illnesses.

“We need to broaden our attention to improve the quality of end-of-life care for all patients, not just those with cancer or dementia,” Melissa Wachterman, MD, MPH, MSc, the lead author, and an assistant professor of medicine at Harvard Medical School, said in a news release. “Our study shows that while there is room for improvement in the quality of end-of-life care for all patients, this is particularly true for patients dying of heart failure, chronic lung disease and renal failure.”

Dr. Wachterman is also a physician both in the Department of Psychosocial Oncology and Palliative Care at Dana-Farber/Brigham and Women’s Cancer Center, and at the VA Boston Healthcare System.

To compare patterns of end-of-life care and family-rated quality of care given patients who died of various serious conditions, the researchers assessed clinical records and conducted family surveys in 146 inpatient facilities using the Veteran Affairs health system between 2009 and 2012. The clinical diagnoses in the study, besides cancer and dementia, included end-stage renal disease (ESRD), frailty,  cardiopulmonary failure (congestive heart failure or chronic obstructive pulmonary disease).

Among 57, 753 patients whose records were reviewed, about half of those with ESRD, frailty, or cardiopulmonary failure had access to a palliative care doctor (50.4 percent, 43.7 percent and 46.7 percent, respectively) versus 73.5 percent of patients with cancer and 61.4 percent of patients with dementia.

The results also revealed that about one-third of these patients died in an intensive care unit, more than double the number of those with dementia or cancer. These patients were also less likely to have “do-not-resuscitate” orders to guide their care.

Overall, findings showed that patients who saw a palliative care specialist doctor had better end-of-life care. “Increasing access to palliative care at the end of life may improve the quality of end-of-life care for those with heart, lung, and kidney diseases — a group that is rapidly growing with the increasing number of aging Americans dying of these conditions,” Wachterman concluded.

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Daniela holds a PhD in Clinical Psychology from The University of Edinburgh, United Kingdom, a MSc in Health Psychology and a BSc in Clinical Psychology. Her work has been focused on vulnerability to psychopathology and early identification and intervention in psychosis.

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