Advance care planning for haemodialysis patients (Intervention Review)

Background. People with chronic kidney disease and end-stage kidney disease (ESKD) have irreversible kidney damage and require renal replacement therapy. In developed countries, haemodialysis has become the most common treatment for people with ESKD. Despite its life-saving potential, haemodialysis can be a significant physical and psychological burden to patients. Advance care planning is the process of planning for a person’s future health and personal care decisions in terms of level of healthcare and quality of life the person would want, should for any reason, the person becomes unable to participate in decision-making. Advance care goals can change over time and advance care planning assists in addressing these changes and readdress care goals over time. This helps to ensure that individual choices are respected in future medical treatment in an event where the person cannot communicate or make decisions. We wanted to find out if advance care planning can improve health outcomes among people with ESKDin terms of use of resuscitation measures such as cardiopulmonary resuscitation, and withdrawal from dialysis. Additionally, we wanted to find out whether patient wishes were followed in the end of life period. Study characteristics. We searched the literature up to June 2016 and found two studies (three reports) that involved 337 patients which investigated use of patient-centred advanced care planning (PC-ACP) and peer mentoring interventions. Key results. Neither study addressed our questions concerning use of life-prolonging treatments such as resuscitation, death in hospital or withdrawal from dialysis. It remains uncertain if advance care planning can improve health outcomes among ESKD patients. More research is required to better inform use of PC-ACP for people receiving haemodialysis treatment.