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Many Kidney Specialists Feel Unprepared for End-of-Life Decisions

Sixty percent of nephrologists don't feel well prepared to make the decision to stop dialysis in kidney disease patients nearing the end of life // , reports a study in the November Clinical Journal of the American Society of Nephrology.

Nephrologists who are more experienced and more familiar with the formal guidelines for end-of-life decision making—developed by the Renal Physicians Association and the American Society of Nephrology (RPA/ASN)—are better prepared, concludes the study, led by Dr. Sara N. Davison of University of Alberta, Edmonton, Canada.

The researchers analyzed responses to a questionnaire regarding end-of-life decision-making by 360 American and Canadian nephrologists. Just 39 percent said they felt "very well prepared" to make the decision to withhold or withdraw dialysis in patients with kidney disease nearing the end of life.

Physicians who were more comfortable in making end-of-life decisions tended to be older and to have more years' experience than those who felt less confident. The well-prepared physicians also had more experience in withdrawing patients from dialysis: an average of 5.6 in the past year, compared with 3.8 for those who felt less well prepared.

Another key factor was awareness of the RPA/ASN guidelines for end-of-life care. Seventy percent of nephrologists who were comfortable with end-of-life decision making were familiar with the guidelines, compared with 52 percent of those who were less comfortable.

One important difference was in preparation to stop dialysis in a patient who had developed permanent and severe dementia—a common situation in patients with kidney disease nearing the end of life. Two-thirds of well-prepared physicians said they were likely to stop dialysis in this situation, compared with just half of nephrologists who rated themselves less well prepared. Handling of other situations covered by the guidelines—eg, a permanently unconscious patient o
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