AI Article Synopsis
- - In a study of 472 patients with end-stage kidney disease (ESKD), pain was the most common symptom (69%) reported in the last week of life, along with other issues like respiratory secretion and anxiety, showcasing significant unmet palliative care needs.
- - Despite expecting death, many patients experienced inadequate relief from their symptoms, with over 30% of those in pain or anxiety reporting only partial relief or none at all.
- - End-of-life discussions were insufficient, occurring in only 41% of patients and impacting families, and many patients lacked access to specialized palliative care services; 19% died alone and only 38% of families received bereavement support.
Article Abstract
Context: End-stage kidney disease (ESKD) is characterized by high physical and psychological burden, and therefore, more knowledge about the palliative care provided close to death is needed.
Objectives: To describe symptom prevalence, relief, and management during the last week of life, as well as end-of-life communication, in patients with ESKD.
Methods: This study was based on data from the Swedish Register of Palliative Care. Patients aged 18 or older who died from a chronic kidney disease, with or without dialysis treatment (International Classification of Diseases, Tenth Revision, Sweden; N18.5 or N18.9), during 2011 and 2012 were selected.
Results: About 472 patients were included. Of six predefined symptoms, pain was the most prevalent (69%), followed by respiratory secretion (46%), anxiety (41%), confusion (30%), shortness of breath (22%), and nausea (17%). Of patients with pain and/or anxiety, 32% and 44%, respectively, were only partly relieved or not relieved at all. Of patients with the other symptoms, a majority (55%-84%) were partly relieved or not relieved at all. End-of-life discussions were reported in 41% of patients and 71% of families. A minority died in specialized palliative care: 8% in hospice/inpatient palliative care and 5% in palliative home care. Of all patients, 19% died alone. Bereavement support was offered to 38% of families.
Conclusion: Even if death is expected, most patients dying with ESKD had unmet palliative care needs regarding symptom management, advance care planning, and bereavement support.
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| http://dx.doi.org/10.1016/j.jpainsymman.2017.09.015 | DOI Listing |
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