title: A palliative approach to dialysis care: a patient-centered transition to the end of life.
abstract: As the importance of providing patient-centered palliative care for patients with advanced illnesses gains attention, standard dialysis delivery may be inconsistent with the goals of care for many patients with ESRD. Many dialysis patients with life expectancy of <1 year may desire a palliative approach to dialysis care, which focuses on aligning patient treatment with patients' informed preferences. This commentary elucidates what comprises a palliative approach to dialysis care and describes its potential and appropriate use. It also reviews the barriers to integrating such an approach into the current clinical paradigm of care and existing infrastructure and outlines system-level changes needed to accommodate such an approach.
authors.affiliation: Division of Nephrology, University of California, San Francisco, San Francisco, California; Division of Nephrology, San Francisco General Hospital, San Francisco, California; grubbsv@medsfgh.ucsf.edu.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Grubbs
authors.affiliation: Section of Nephrology, Department of Medicine, West Virginia University School of Medicine, Morgantown, West Virginia;
authors.forename: Alvin H
authors.initials: AH
authors.lastname: Moss
authors.affiliation: Department of Psychiatry, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts;
authors.forename: Lewis M
authors.initials: LM
authors.lastname: Cohen
authors.affiliation: Division of Nephrology, Jesse Brown Veterans Affairs Medical Center, University of Illinois Hospital and Health Sciences Center, Chicago, Illinois;
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fischer
authors.affiliation: Division of Nephrology, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts;
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Germain
authors.affiliation: Division of Nephrology, University Health Network and.
authors.forename: S Vanita
authors.initials: SV
authors.lastname: Jassal
authors.affiliation: Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada;
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Perl
authors.affiliation: Division of Nephrology, Tufts Medical Center, Boston, Massachusetts; and.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Weiner
authors.affiliation: Division of Nephrology, University of Washington, Seattle, Washington.
authors.forename: Rajnish
authors.initials: R
authors.lastname: Mehrotra
mesh_terms: D003142:Communication; D006699:Home Care Services; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D010166:Palliative Care / Q000191:economics; D010347:Patient Care Planning; D010353:Patient Education as Topic; D057240:Patient Preference; D018802:Patient-Centered Care; D011379:Prognosis; D011788:Quality of Life; D006435:Renal Dialysis / Q000191:economics; D013727:Terminal Care / Q000191:economics
keywords: dialysis; end of life; palliative care
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