Shared Decision Making and Renal Supportive Care
Lewis Mitchel Cohen, MD
Baystate Medical Center
Communication and Dissemination Research
While most of us think of dialysis as a life-saving treatment for people who develop kidney failure, the unfortunate reality is that more than one-fifth of those who receive this arduous and time consuming therapy will die each year. This is not a tragic consequence of dialysis, but rather reflects [the fact] (sic) that most of the people are quite elderly and have diseases like diabetes that continue to take a toll on their hearts, brains, limbs, eyes, and other organs, in addition to the kidneys. It is tragic that we now can predict which individuals are most likely to die within the next 6 months, and yet dialysis staff rarely sit down with them and their loved ones to discuss the situation. They die without completing advance directives, appointing healthcare proxies, or knowing they have the right to stop dialysis. They die in intensive care units, hospitals, and nursing homes, and are never given the opportunity to discuss the possibility of receiving hospice services and dying at home surrounded by friends and loved ones. This study is based on preliminary research that started with patient, family, and caregiver focus groups, created a tool for predicting mortality, and went on to develop a communication intervention that successfully increased the use of hospice services in several Massachusetts dialysis clinics. We now wish, with our PCORI patient-partners and stakeholders, including hospices and dialysis companies, to improve the intervention and [demonstrate] (sic) its effect on additional dialysis clinics in New Mexico, [in addition to] (sic) New England. We believe that this innovative clinical model can then be [disseminated] (sic) throughout the country.