Kidney Clinicians' Perceptions of Challenges and Aspirations to Improve End-Of-Life Care Provision

Introduction: End-of-life care is an essential part of integrated kidney care. However, renal clinicians' experiences of care provision and perceptions of end-of-life care needs are limited. This study explored renal clinicians' experiences of providing end-of-life care and developed recommendations to improve experiences. Methods: An exploratory qualitative study using semistructured focus groups and 1 interview was un-dertaken at 5 kidney services in Victoria, Australia. The transcripts were analyzed thematically. Results: Between February and December 2017, 54 renal clinicians (21 doctors and 33 nurses) participated in the study. Clinicians reported multiple challenges of end-of-life care experiences resulting in compro-mised treatment planning and decision making and highlighted priorities to guide better care experiences. Challenges of providing end-of-life care were underpinned by mismatches in illness and treatment ex-pectations, limited engagement in advance care planning, medical complexity, and differences between clinicians and patients in what constituted quality of life. These challenges were associated with compromised end-of-life care planning, which resulted in care experiences that were rushed with a pro-longed treatment focus, risking limited preparation for death and moral distress. Clinicians aspired for positive end-of-life care experiences, including patient control and consensus in decision making, and a coordinated and collaborative approach across healthcare providers. Conclusions: Renal clinicians highlighted multiple factors and circumstances which resulted in experi-ences of compromised end-of-life care for patients with kidney disease. To improve care experiences, clinician-directed priorities included more training and support to facilitate systematic and earlier dis-cussions about illness expectations and end-of-life care planning and greater communication and collaboration across healthcare providers is required.