Nephrology and Palliative Care Collaboration in the Care of Patients With Advanced Kidney Disease: Results of a Clinician Survey

Rationale & Objective: Despite calls for integrating palliative care into chronic kidney disease (CKD) care, uptake remains low. The study aim was to describe clinicians' perceptions of the clinical and research priorities in CKD care and the main barriers to collaboration. Study Design: This was a descriptive cross-sectional study using an online survey developed by clinicians and researchers as the primary data collection method. Setting & Participants: Clinicians in nephrology and palliative care departments (N = 195) at an academic health center in Virginia were invited to participate. Of the 48.7% (n = 95) who responded, most were registered nurses (65.3%) in nephrology (80%) with more than 15 years' experience (40%). Predictors: Factors including discipline (nursing, social work, and physician) and practice area (palliative care or nephrology) were assessed. Outcomes: Main outcomes of interest included clinicians' perceptions of the role of palliative care, barriers to collaboration, and the top clinical and research priorities for patients with advanced CKD. Analytic Approach: Survey data were analyzed using SPSS using descriptive statistics. Results: Respondents reported being comfortable caring for patients near the end of life and endorsed advance care planning and collaboration between nephrology and palliative care teams. However, both rarely happen. Fragmentation, or poor coordination of care, was perceived to be the main barrier to collaboration. Perceptions regarding collaboration facilitation differed; nephrology clinicians identified patient/family education as the most important facilitator while palliative care clinicians identified clinician education as most important. Top clinical priorities differed. Palliative care clinicians reported pain/symptom management as taking priority while nephrology clinicians identified caregiver/family support. Developing interventions to support treatment-related decision making was the top research priority. Limitations: Results reflect perceptions of about half the clinicians at 1 academic health center. Conclusions: Additional studies to capture patients' and families' perspectives and examine end-of-life care processes are needed. Results may inform future targeted interventions.