title: Establishing a supportive care register improves end-of-life care for patients with advanced chronic kidney disease.
abstract: BACKGROUND
  End-of-life care for patients with advanced chronic kidney disease (CKD) is recognised as an important area for improvement. These patients have a significant mortality and, although some is unpredictable, there is a role for the nephrology multi-disciplinary team (MDT) and palliative care physicians to engage in advance care planning and support patients to discuss their preferences.
  
  
  METHODS
  Retrospective and prospective data were obtained to conduct a comparison observational study to assess the impact of introducing a supportive care register on the end-of-life care for patients with advanced CKD. An electronic supportive care register was implemented. This required a programme of multi-disciplinary staff education, collaborative working with Palliative Care to establish renal-specific protocols and dissemination activities. The impact of the intervention was assessed by analysing all deaths in two six-month periods where all those with an eGFR <15 ml/min/1.73 m(2) at the time of their death were included.
  
  
  RESULTS
  A total of 91 patients were included. Post-intervention, there was a 25.4% (95% CI: 6.5-44.3%, p = 0.008) improvement in patients having a documented discussion about end-of-life planning. There was also a 19.7% (95% CI: 4.0-35.5%, p = 0.01) improvement in establishing the place of death. All patients who expressed a preferred place of death died there. The intervention increased engagement with the wider MDT and led to significant improvements in access to specialist palliative care services.
  
  
  CONCLUSIONS
  These results show that the interventions implemented to introduce a supportive care register resulted in meaningful improvements to the end-of-life care for patients in our region with advanced CKD. © 2015 S. Karger AG, Basel.
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Harrison
authors.forename: Laura E
authors.initials: LE
authors.lastname: Clipsham
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Cooke
authors.forename: Graham
authors.initials: G
authors.lastname: Warwick
authors.forename: James O
authors.initials: JO
authors.lastname: Burton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000458:organization & administration*; D010347:Patient Care Planning; D010348:Patient Care Team; D011446:Prospective Studies; D006435:Renal Dialysis / Q000706:statistics & numerical data; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D013727:Terminal Care / Q000458:organization & administration*