title: An appraisal of end-of-life care in persons with chronic kidney disease dying in hospital wards.
abstract: OBJECTIVE
  To review end-of-life care provided by renal healthcare professionals to hospital in-patients with chronic kidney disease, and their carers, over a 12-month period in Northern Ireland.
  
  
  METHODS
  Retrospective review of 100 patients.
  
  
  RESULTS
  Mean age at death was 72 years (19-95) and 56% were male. Eighty three percent of patients had a 'Not For Attempted Resuscitation' order during their last admission and this was implemented in 42%. Less than 20% of all patients died in a hospital ward. No patients had an advanced care plan, although 42% had commenced the Liverpool Care Pathway for the Dying Patient. Patients suffered excessive end-of-life symptoms. In addition, there was limited documentation of carer involvement and carer needs were not formally assessed.
  
  
  CONCLUSIONS
  End-of-life care for patients with advanced chronic renal disease can be enhanced. There is significant variation in the recording of discussions regarding impending death and little preparation. There is poor recording of the patients' wishes regarding death. Those with declining functional status, including those frequently admitted to hospital require holistic assessment regarding end-of-life needs. More effective communication between the patient, family and multi-professional team is required for patients who are dying and those caring for them.
authors.affiliation: Queen's University Belfast, School of Nursing and Midwifery, Belfast, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Noble
authors.forename: Joan
authors.initials: J
authors.lastname: Brown
authors.forename: Joanne
authors.initials: J
authors.lastname: Shields
authors.forename: Damian
authors.initials: D
authors.lastname: Fogarty
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Maxwell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015438:Health Behavior; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000451:nursing*; D007677:Kidney Function Tests / Q000451:nursing; D008297:Male; D008875:Middle Aged; D009660:Northern Ireland; D016016:Proportional Hazards Models; D016414:Resuscitation Orders; D012189:Retrospective Studies; D013727:Terminal Care / Q000592:standards*; D055815:Young Adult
keywords: Audit; Chronic kidney disease; End-of-life care; Palliative care