How to include palliative care in training of nephrologist doctors: Literature review
Keywords:Palliative Care; Chronic Renal Insufficiency; Advance Care Planning; Nephrology.
Objective: The article aims to present the advantages of palliative care (PC) for patients with chronic kidney disease (CKD) and highlight the knowledge needed by nephrologists to offer holistic and appropriate treatment to these patients. Methods: This review was produced using Pubmed (American National Library of Medicine), the Virtual Health Library (VHL) and the Scientific Eletronic Library Online (SciELO). The advanced search had as descriptors: palliative care, chronic kidney disease and advance care planning. Subsequently, articles in English and Portuguese with publications between 2015 and 2020 were filtered, with the most relevant being selected. Results: The analysis of the references elucidated the PC and its role in CKD, the skills inherent to nephrologists and the main symptoms of patients with CKD. Conclusion: The early introduction of palliative care is necessary to improve the quality of life of patients with CKD, without restricting it to end-of-life measures and without excluding interventionist procedures. Thus, it is essential to invest in the training of nephrologists to meet the demands of palliative care in CKD.
Academia Nacional de Cuidados Paliativos. (2018). Análise situacional e recomendações para estruturação de programas de cuidados paliativos no Brasil. Ministério da Saúde. https://paliativo.org.br/wp-content/uploads/2018/12/ANALISE-SITUACIONAL_ANCP-18122018.pdf.
Bansal, A. D., Leonberg-Yoo, A., Schell, J. O., Scherer, J. S., & Jones, C. A. (2018). Ten Tips Nephrologists Wish the Palliative Care Team Knew About Caring for Patients with Kidney Disease. Journal of palliative medicine, 21(4), 546–551. https://doi.org/10.1089/jpm.2018.0087
Bleyer, A., & Golper, T. A. (2019). Incorporating residual kidney function into the dosing of intermittent hemodialysis. UpToDate. Retirado Setembro 19, 2019, de: https://www.uptodate.com/contents/incorporating-residual-kidney-function-into-the-dosing-of-intermittent-hemodialysis?source=history_widget
Brown, M. A., Collett, G. K., Josland, E. A., Foote, C., Li, Q., & Brennan, F. P. (2015). CKD in Elderly Patients Managed without Dialysis: Survival, Symptoms, and Quality of Life. Clinical Journal of the American Society of Nephrology, 10(2), 260–268. doi:10.2215/cjn.03330414
Academia Nacional de Cuidados Paliativos (2020). O Manual de Cuidados Paliativos ANCP. Ministério da Saúde. http://biblioteca.cofen.gov.br/wp-content/uploads/2017/05/Manual-de-cuidados-paliativos-ANCP.pdf.
Chettiar, A., Montez-Rath, M., Liu, S., Hall, Y. N., O'Hare, A. M., & Kurella Tamura, M. (2018). Association of Inpatient Palliative Care with Health Care Utilization and Postdischarge Outcomes among Medicare Beneficiaries with End Stage Kidney Disease. Clinical journal of the American Society of Nephrology : CJASN, 13(8), 1180–1187. https://doi.org/10.2215/CJN.00180118
Clark, D., Baur, N., Clelland, D., Garralda, E., López-Fidalgo, J., Connor, S., & Centeno, C. (2019). Mapping levels of palliative care development in 198 countries: the situation in 2017. Journal of Pain and Symptom Management, 59, 794-807. doi:10.1016/j.jpainsymman.2019.11.009
Davison S. N. (2010). End-of-life care preferences and needs: perceptions of patients with chronic kidney disease. Clinical journal of the American Society of Nephrology: CJASN, 5(2), 195–204. https://doi.org/10.2215/CJN.05960809
Davison, S. N.,& Jassal, S. V. (2016). Supportive Care: Integration of Patient-Centered Kidney Care to Manage Symptoms and Geriatric Syndromes. Clinical Journal of the American Society of Nephrology, 11(10), 1882–1891. doi:10.2215/cjn.01050116
Davison, S. N., Jhangri, G. S., & Koffman, J. (2014). Knowledge of and attitudes towards palliative care and hospice services among patients with advanced chronic kidney disease. BMJ Supportive & Palliative Care, 6(1), 66–74. doi:10.1136/bmjspcare-2013-000610
Davison, S. N., Koncicki, H., & Brennan, F. (2014). Pain in Chronic Kidney Disease: A Scoping Review. Seminars in Dialysis, 27(2), 188–204. doi:10.1111/sdi.12196.
Eckert, K., Motemaden, L., & Alves, M. (2018). Effect of Hemodialysis Compared With Conservative Management on Quality of Life in Older Adults With End-Stage Renal Disease. Journal of Hospice & Palliative Nursing, 20(3), 279–285. doi:10.1097/njh.0000000000000444.
Gelfand, S. L., Scherer, J. S., & Koncicki, H. M. (2020). Kidney Supportive Care: Core Curriculum 2020. American Journal of Kidney Diseases, 75, 793-806. doi:10.1053/j.ajkd.2019.10.016.
Germain, M. J. (2015). How to Integrate Predictions in Outcomes in Planning Clinical Care. Blood Purification, 39, 65–69. doi:10.1159/000368946.
Glickman, J. D., & Chan, C. (2021). Home hemodialysis (HHD): Establishment of a program. UpToDate. Retirado Setembro 04, 2019, de: https://www.uptodate.com/contents/incorporating-residual-kidney-function-into-the-dosing-of-intermittent-hemodialysis?source=history_widget.
Koncicki, H. M., & Schell, J. O. (2016). Communication Skills and Decision Making for Elderly Patients With Advanced Kidney Disease: A Guide for Nephrologists. American journal of kidney diseases: the official journal of the National Kidney Foundation, 67(4), 688–695. https://doi.org/10.1053/j.ajkd.2015.09.032
Mettang, T., & Kremer, A. E. (2015). Uremic pruritus. Kidney International, 87(4), 685–691. doi:10.1038/ki.2013.454
Ministério da Educação. (2019). Matriz de Competências em Nefrologia. http://portal.mec.gov.br/index.php?option=com_docman&view=download&alias=128181-matriz-nefrologia-publ&category_slug=novembro-2019&Itemid=30192
Moskovitch, J. T., Mount, P. F., & Davies, M. R. P. (2019). Changes in Symptom Burden in Dialysis Patients Assessed Using a Symptom-Reporting Questionnaire in Clinic. Journal of Palliative Care, 35, 59-65. doi:10.1177/0825859719827315
Neto, J. A. M., Moura, A. F. S., & Suassuna, J. H. R. (2017). Renouncement of renal replacement therapy: withdrawal and refusal. Brazilian Journal of Nephrology, 39(3), 312-322. https://doi.org/10.5935/0101-2800.20170054
Pirkle, J. L., & Junior, M.D. (2020). Prescribing peritoneal dialysis. UpToDate. Retirado Maio 11,2020, de: https://www.uptodate.com/contents/prescribing-peritoneal- dialysis
Quill, T. E., & Abernethy, A. P. (2013). Generalist plus Specialist Palliative Care — Creating a More Sustainable Model. New England Journal of Medicine, 368(13), 1173–1175. doi:10.1056/nejmp1215620.
Scherer, J. S., Wright, R., Blaum, C. S., & Wall, S. P. (2017). Building an Outpatient Kidney Palliative Care Clinical Program. Journal of Pain and Symptom, 55, 108–116. doi:10.1016/j.jpainsymman.2017.08.005.
Shah, H. H., Monga, D., Caperna, A., & Jhaveri, K. D. (2013). Palliative care experience of US adult nephrology fellows: a national survey. Renal Failure, 36(1), 39–45. doi:10.3109/0886022x.2013.831718
Siriwardana, A. N., Hoffman, A. T., Brennan, F. P., Li, K., & Brown, M. (2020). A Impact of Renal Supportive Care on Symptom Burden in Dialysis Patients: A Prospective Observational Cohort Study. Journal of Pain and Symptom Management, 60, 725-736. doi: 10.1016/j.jpainsymman.2020.04.030
Song, M. K. (2016). Quality of Life of Patients with Advanced Chronic Kidney Disease Receiving Conservative Care without Dialysis. Seminars in dialysis, 29(2), 165–169. https://doi.org/10.1111/sdi.12472 .
Thumfart, J., Reindl, T., Rheinlaender, C., & Müller, D. (2017). Supportive palliative care should be integrated into routine care for paediatric patients with life-limiting kidney disease. Acta Paediatrica, 107(3), 403–407. doi:10.1111/apa.14182
Wachterman, M. W., Hailpern, S. M., Keating, N. L., Kurella Tamura, M., & O'Hare, A. M. (2018). Association Between Hospice Length of Stay, Health Care Utilization, and Medicare Costs at the End of Life Among Patients Who Received Maintenance Hemodialysis. JAMA internal medicine, 178(6), 792–799. https://doi.org/10.1001/jamainternmed.2018.0256
World Health Organization (2016). Planning and implementing palliative care services: a guide for programme managers. World Health Organization. http://www.who.int/ncds/management/palliative-care/palliative_care_services/en/.
How to Cite
Copyright (c) 2021 Ana Clara Aragão Fernandes; Jayana Teixeira Jales Menescal Pinto; Larissa Câmara Nascimento de Melo; Juliana Ferreira Duarte; Felipe Leite Guedes
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.