Integrating Palliative Care in the Dialysis Facility: A Systems Approach
The overarching goal of this project is to systematically integrate palliative care and advance care planning into the routine care delivery of end-stage renal disease (ESRD) patients across an entire dialysis provider system. This project has three specific aims: 1) conduct a qualitative study among key stakeholders to identify potential barriers and facilitators to integrating advance care planning and palliative care into the routine care of patients undergoing maintenance dialysis at Northwest Kidney Centers (NKC); 2) develop and implement a program to integrate palliative care and advance care planning into the care of patients with ESRD receiving care at NKC; and 3) evaluate the feasibility, acceptability and impact of this program on patterns of healthcare utilization among patients served at NKC.
I was a second-year internal medicine resident, the first doctor in the family, an immigrant to the medical culture from a family of immigrants. I learned from my family that my grandmother had a brain tumor and was declining, though it was unclear to what extent. I booked a flight to Toronto and met my family at the hospital, but little did we know that we were in for an unceremonious experience in the callousness of the healthcare system. It was an experience marked by lack of communication, lack of compassion, lack of presence, and lack of empathy, all culminating the morning after my grandmother’s death. My sister and I were with my grandmother the night she died and met her doctor the next morning. Hurried, impatient, averting eye contact, she flatly stated, “I am just here to pronounce her, I don’t know anything about her.” And with that, she left.
It was the impetus for me to seek additional training in palliative care, with the belief that we can change our health care system and that the first step for me was to learn the necessary tools to do so. My hope is to bring about a transformation in how we care for people, and specifically how we care for people with advanced kidney disease. My belief is that integration of palliative care in the care of patients with advanced kidney disease will advance the goal of improving the experience of living with kidney disease.