Dialysis Management Rarely Mentioned in Advance Directives

Highlights

• Among people on dialysis, only 49% had advance directives, finds a study by doctors from Mayo Clinic.
• Only 10.6% mentioned dialysis and only 3% mentioned dialysis management in advance directives.
• Advance directives should be prepared in consultations with the individual, loved one and the doctor.

There is increased awareness about preparing advanced directives which are documents that specify a patient's need for care and preference for the line of care, in the event of a situation when the patient may be unable to make conscious decisions. A study that analyzed the directives of advanced care patients, only a small percentage included directives on managing dialysis.

The study was published in the Journal Clinical Journal of the American Society of Nephrology (CJASN) highlights issues concerning advanced directives, where preparing an advanced directive should detail more about the end of care that should be received.

Preparing Advance Directives

Advance directives should be prepared after conversations with patients, about their goals, preferences and their values which can be used to determine their end of life care. This will help manage care for people in need and should be recorded with the living will. Apart from the individual, loved ones and the individual's doctor should be consulted to ensure the line of treatment is in accordance with the individual's needs and wishes. The presence of the doctor would aid in highlighting the medical treatments that are available based on any physical ailment that the individual could be suffering from.

Analyzing Advance Directives

Dr. Molly Feely and colleagues from the Mayo Clinic analyzed actual directives from patients who were undergoing dialysis. The medical records of 808 patients who received in -hospital dialysis between January 2007 and January 2012 were studied.

It was found that among 808 patients -

• 49% had advance directives
• only 10.6% mentioned dialysis
• only 3% mentioned  dialysis management specifically at the end of life

Importantly, among patients who received dialysis and who had advance directives

• 44.2% mentioned cardiopulmonary resuscitation
• 37.1% mentioned mechanical ventilation
• 34.3% mentioned artificial nutrition and hydration
• 43.4% mentioned pain management
• 10.6% mentioned dialysis

There was considerable thought that went into preparing advance directives and they were tailored to include conditions of the heart but many people who were on dialysis had failed to mention the need for one.  The directives were particularly important for these patients as they would have guided the doctors on assessing treatment plans and managing dialysis.

Dr. Feely added, "Unfortunately, our study revealed that the advance directives of our dialysis patients failed to address how our patients wanted to manage their dialysis at the end of life, an issue of critical importance to this population. Future research needs to be much more sophisticated in how we measure the success of advance care planning and advance directive execution such that we assure that we are actually improving patient outcomes."

Dr. Sara Combs from The University of Colorado stated along with this study that The United States had the financial capacity to provide dialysis for nearly every citizen, even if they did not have the financial resources to fund their dialysis procedure on their own.

Dialysis is a life-sustaining procedure and patients' needs to be informed about the benefits associated with this procedure. The researchers conclude that stopping dialysis or not taking up dialysis are also viable options that may be considered.

Dialysis

Dialysis  is a procedure in which some of the functions of the kidney are performed by a dialysis machine. It is performed in conditions where the kidney is unable to perform its functions well, resulting in a toxic build-up of waste.

Dialysis aids in keeping your body in balance by

• Removing extra water, waste and salt
• Maintaining levels of sodium, potassium and calcium
• Aids in controlling blood pressure

The duration of dialysis depends on the stage of kidney disease. In some patients, dialysis may be needed only for a short period of time, while in people with end-stage kidney disease; dialysis may have to be carried out for the rest of their lives. Such people could opt for a kidney transplant.

It is important for the patient to understand the need for dialysis and to make an informed mention in the advance directives, to better manage end of life care.

References:

1. Dialysis - (https://www.kidney.org/atoz/content/dialysisinfo)

Source: Medindia