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

r a request by a patient who was competent to make such a request—was similar between groups.

Despite continuing technological improvements in care, more than 80,000 chronic dialysis patients die each year in the United States, with an annual mortality rate of up to 25 percent per year. Increasingly, kidney specialists play a central role in making decisions, along with patients and/or families, about withholding or withdrawing dialysis. "Unfortunately, these discussions often occur late in illness, when patients are suffering and are often too ill to make decisions for themselves," says Dr. Davison. "In fact, patients often do not know that they have the option to withdraw from dialysis, while others erroneously believe that their physician would not support such an option."

The results show that clinical experience is more important than education in preparing nephrologists to deal with these complex decisions. "This is not surprising, given that end-of-life care is not well addressed in nephrology specialty training programs," Dr. Davison adds.

Many health professionals believe that end-of-life discussions may destroy hope for dialysis patients. "In contrast, our recent research suggests that end-of-life discussions through the provision of timely, appropriate information can positively enhance rather than diminish patients' hope," says Dr. Davison. "Dialysis patients prefer that these conversations happen early in the illness and expect their physicians to initiate and guide the discussion—even if for some patients, much of the discussion occurs with family members, outside the patient-physician relationship."



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