AI Article Synopsis

  • Nephrologists in Korea face dilemmas when deciding to withhold or withdraw dialysis and provide palliative care for end-of-life patients, with 87.3% deeming these actions ethically appropriate.
  • A survey of 369 nephrologists revealed that key factors influencing these decisions include dialysis intolerance and poor performance status, with the majority advocating for withdrawal in patients aged 80-90.
  • There is a call for improved palliative care facilities, treatment guidelines, and resources to support nephrologists in managing complex end-of-life care situations.

Article Abstract

Nephrologists commonly engage in decision making regarding the withholding or withdrawal of dialysis and palliative care in patients at end of life (EoL). However, these issues remain an unsolved dilemma for nephrologists. To explore nephrologists' perceptions on the decision-making process about withholding or withdrawing dialysis and palliative care in Korea. A nationwide 25-item questionnaire online survey via e-mail. A total of 369 Korean nephrologists completed the survey. The proportions of respondents who stated that withholding or withdrawing dialysis at EoL is ethically appropriate were 87.3% and 86.2%, respectively. A total of 72.4% respondents thought that withdrawal of dialysis in a maintenance dialysis patient is ethically appropriate. Responses regarding patient features that should be considered to withhold or withdraw dialysis were as follows: dialysis intolerance (84.3%), poor performance status (74.8%), patient's active request (47.2%), age (28.7%), very severe dementia (27.1%), and several comorbidities (16.5%). Among those nephrologists who responded to the question about the minimum age, at which dialysis should be withheld or withdrawn, most specified an age between 80 and 90 years (94.3%). Fifty-eight percent of respondents stated that terminally ill dialysis patients should be allowed to use palliative care facilities. In addition, a number of nephrologists thought that adequate palliative care facilities, specific treatment guidelines, enough time to manage patients, financial support, and adequate medical experts are necessary. Korean nephrologists thought that withholding or withdrawing dialysis at EoL is ethically appropriate, even in maintenance dialysis patients. Therefore, consensus guidelines for palliative care after withholding or withdrawal of dialysis are needed.

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Source
http://dx.doi.org/10.1089/jpm.2020.0248DOI Listing

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