title: Insight into advance care planning for patients on dialysis.
abstract: BACKGROUND
  Advance care planning is not included in regular clinical care for patients on dialysis. Insight into life-sustaining treatment preferences and communication about end-of-life care is necessary to develop interventions to improve advance care planning for patients on dialysis.
  
  
  OBJECTIVE
  This cross-sectional observational study aimed to understand the preferences for life-sustaining treatments of outpatients on dialysis and to study the quality of patient-physician communication about end-of-life care and barriers and facilitators to this communication.
  
  
  METHODS
  The following outcomes were assessed in 80 clinically stable dialysis patients: demographics, clinical characteristics, life-sustaining treatment preferences (cardiopulmonary resuscitation and mechanical ventilation, and Willingness to Accept Life-Sustaining Treatment instrument), preference for site of death, quality of communication (Quality of Communication Questionnaire), and barriers and facilitators to communication about end-of-life care (Barriers and Facilitators Questionnaire).
  
  
  RESULTS
  Patients were able to indicate their preferences for life-sustaining treatments and site of death. Preferences for life-sustaining treatments depend on the specific treatment, the expected outcome of treatment, and likelihood of an adverse outcome. Life-sustaining preferences were discussed with the nephrologist by 30.3% of the patients. Quality of the patient-physician communication about end-of-life care was rated poor. This study identified several barriers and facilitators to end-of-life care communication.
  
  
  CONCLUSIONS
  Patients should receive information about treatment burden, expected outcome, and the likelihood of an adverse outcome when discussing life-sustaining treatments. Quality of patient-physician communication about end-of-life care needs to improve. Barriers and facilitators to communication about end-of-life care provide direction for future interventions to facilitate advance care planning for patients on dialysis.
authors: Program Development Centre, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands. daisyjanssen@ciro-horn.nl
authors: Daisy J A
authors: DJ
authors: Janssen
authors: Martijn A
authors: MA
authors: Spruit
authors: Jos M G A
authors: JM
authors: Schols
authors: Frank M
authors: FM
authors: van der Sande
authors: Leon A
authors: LA
authors: Frenken
authors: Emiel F M
authors: EF
authors: Wouters
mesh_terms: D032722:Advance Care Planning; D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003430:Cross-Sectional Studies; D003956:Dialysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires; D013727:Terminal Care