title: A concept analysis of renal supportive care: the changing world of nephrology.
abstract: OBJECTIVE
  This paper is a report of a concept analysis of renal supportive care.
  
  
  BACKGROUND
  Approximately 1.5 million people worldwide are kept alive by renal dialysis. As services are required to support patients who decide not to start or to withdraw from dialysis, the term renal supportive care is emerging. Being similar to the terms palliative care, end-of-life care, terminal care and conservative management, there is a need for conceptual clarity.
  
  
  METHODS
  Rodgers' evolutionary method was used as the organizing framework for this concept analysis. Data were collected from a review of CINAHL, Medline, PsycINFO, British Nursing Index, International Bibliography of the Social Sciences and ASSIA (1806-2006) using, 'renal' and 'supportive care' as keywords. All articles with an abstract were considered. The World Wide Web was also searched in English utilizing the phrase 'renal supportive care'.
  
  
  RESULTS
  Five attributes of renal supportive care were identified: available from diagnosis to death with an emphasis on honesty regarding prognosis and impact of disease; interdisciplinary approach to care; restorative care; family and carer support and effective, lucid communication to ensure informed choice and clear lines of decision-making.
  
  
  CONCLUSIONS
  Renal supportive care is a dynamic and emerging concept relevant, but not limited to, the end phase of life. It suggests a central philosophy underpinning renal service development that allows patients, carers and the multidisciplinary team time to work together to realize complex goals. It has relevance for the renal community and is likely to be integrated increasingly into everyday nephrology practice.
authors.affiliation: Care for Older Adults Research Team, St Bartholomew School of Nursing & Midwifery, City University, London, UK. H.R.Noble@city.ac.uk
authors.forename: Helen
authors.initials: H
authors.lastname: Noble
authors.forename: Daniel
authors.initials: D
authors.lastname: Kelly
authors.forename: Karen
authors.initials: K
authors.lastname: Rawlings-Anderson
authors.forename: Julienne
authors.initials: J
authors.lastname: Meyer
mesh_terms: D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D010166:Palliative Care; D006435:Renal Dialysis; D009626:Terminology as Topic