Advance care planning: The patient perspective.

Advance directives ensure that an individual's wishes for health care are honored. Only about one-half of dialysis patients have advance directives, and less than 10% of patients have had discussions about end-of-life care with their physicians. The Coalition for Supportive Care of Kidney Patients interviewed patients regarding their experience completing advance directives.

An interdisciplinary approach to dialysis decision-making in the CKD patient with depression.

Depression and depressive symptoms are common in advanced kidney disease and are associated with poor outcomes. For those with CKD not on dialysis, depression may influence how patients cope and prepare for their disease and its management, including decisions about dialysis treatment. Patient self-reported scales exist to better identify depression; how to incorporate these scales into clinical practice and assist with treatment decision-making is less clear.

The demented patient who declines to be dialyzed and the unhappy armed police officer son: what should be done?

Dialysis personnel are responsible for ensuring that patients' rights and physical safety are protected in dialysis centers. Treatment of patients with cognitive impairment, including patients with dementia, presents special challenges. These patients may attempt to pull out their dialysis needles during treatment, potentially endangering themselves, dialysis center personnel, and other patients.

Hospice and ESRD: knowledge deficits and underutilization of program benefits.

Although hospice care for dying patients on dialysis has been recommended in clinical practice guidelines and policy statements of professional nephrology organizations, only a minority of dying patients on dialysis currently receive hospice services. This retrospective qualitative study investigated a variety of factors contributing to the low referral rate for patients with end stage renal disease (ESRD). Interviews (N=338) were conducted with dialysis facility professionals (RN staff nurses, social workers, nurse managers) in ESRD networks 1, 5, and 12 using a standardized telephone survey.