title: Should there be an expanded role for palliative care in end-stage renal disease?
abstract: OBJECTIVE
  In this review, we outline the rationale for expanding the role of palliative care in end-stage renal disease (ESRD), describe the components of a palliative care model, and identify potential barriers in implementation.
  
  
  RESULTS
  Patients receiving chronic dialysis have reduced life expectancy and high rates of chronic pain, depression, cognitive impairment, and physical disability. Delivery of prognostic information and advance care planning are desired by patients, but occur infrequently. Furthermore, although hospice care is associated with improved symptom control and lower healthcare costs at the end of life, it is underutilized by the ESRD population, even among patients who withdraw from dialysis. A palliative care model incorporating communication of prognosis, advance care planning, symptom assessment and management, and timely hospice referral may improve quality of life and quality of dying. Resources and clinical practice guidelines are available to assist practitioners with incorporating palliative care into ESRD management.
  
  
  CONCLUSIONS
  There is a large unmet need to alleviate the physical, psychosocial, and existential suffering of patients with ESRD. More fully integrating palliative care into ESRD management by improving end-of-life care training, eliminating structural and financial barriers to hospice use, and identifying optimal methods to deliver palliative care are necessary if we are to successfully address the needs of an aging ESRD population.
authors.affiliation: Division of Nephrology, Stanford University School of Medicine and Geriatric Research and Education Clinical Center, Palo Alto Veterans Affairs Healthcare System, Palo Alto, California, USA. mktamura@stanford.edu
authors.forename: Manjula
authors.initials: M
authors.lastname: Kurella Tamura
authors.forename: Lewis M
authors.initials: LM
authors.lastname: Cohen
mesh_terms: D032722:Advance Care Planning; D019033:Delivery of Health Care, Integrated; D017051:Hospice Care; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000523:psychology / Q000628:therapy*; D010166:Palliative Care; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D012017:Referral and Consultation; D006435:Renal Dialysis; D016896:Treatment Outcome