title: Knowledge of and attitudes towards palliative care and hospice services among patients with advanced chronic kidney disease.
abstract: OBJECTIVE
  Palliative care is greatly underutilised for patients dying from advanced chronic kidney disease (CKD). This study explored CKD patients' knowledge of, and attitudes to, palliative and hospice care.
  
  
  METHODS
  This was a cross-sectional interview-based survey of stage 5 CKD patients.
  
  
  METHODS
  Both dialysis patients and those managed without dialysis were assessed in a university-based renal programme in Alberta, Canada.
  
  
  METHODS
  The primary outcome was validated patient knowledge of, and attitudes, towards palliative and hospice care. Secondary analyses of associations between knowledge and potential explanatory variables such as patient demographics, living circumstances, self-assigned ethnicity, socioeconomic position and sources of knowledge were explored.
  
  
  RESULTS
  Only 22.2% and 17.9% of 436 patients surveyed possessed a correct understanding of palliative and hospice care, respectively, and perceptions were mostly negative. Sources of knowledge of these services rarely involved healthcare professionals (3.1%-7.7%). Multivariable analysis identified that white participants were more than 12 times more likely to have accurate knowledge than non-Caucasian patients, not accounted for by socioeconomic position. Accurate knowledge was also more likely among patients who had personal experience with palliative care, or obtained their knowledge firsthand from family and friends. After palliative and hospice care were described, the vast majority of patients felt these services were valuable and should be offered to patients with advanced CKD (87.8% and 89.7%, respectively).
  
  
  CONCLUSIONS
  Based on study findings, CKD patient and family education about the benefits of palliative and hospice services is likely important in optimal use of these services.
authors.affiliation: Division of Nephrology & Immunology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Sara N
authors.initials: SN
authors.lastname: Davison
authors.affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Gian S
authors.initials: GS
authors.lastname: Jhangri
authors.affiliation: Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, King's College London School of Medicine, London, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Koffman
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D017051:Hospice Care / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data*; D051436:Renal Insufficiency, Chronic / Q000451:nursing*