title: Dialysis Withdrawal: Impact and Evaluation of a Multidisciplinary Deliberation Within an Ethics Committee as a Shared-Decision-Making Model.
abstract: Since dialysis withdrawal in maintenance dialysis patients with limited life expectancy results always in short-term death, nephrologists need a referenced process to make their decision. This study reviews 8 years of operation of an Ethics Committee in Nephrology (ECN). The ECN, within a multidisciplinary team, once a month explores cases reported by caregivers when maintaining dialysis seems not to be in the patient's best interest. Discussion is required when the vital prognosis is engaged by the evolution of the chronic kidney disease (CKD) or the occurrence of an acute medical event. Data are analyzed using a discussion guide. The informed decision is completed with an appropriated palliative care project involving the patient, and recorded in their file. Since 2006, the ECN has deliberated yearly for 10 sessions on 6-18 cases, concerning 380 identified maintenance dialysis patients. Characteristics of the population, cases, sessions and proposals are recorded and analyzed. The only variable associated with dialysis withdrawal was having at least one new comorbid condition. End of life is supported with the help of the palliative care team in the hospital or exceptionally at home. The ECN, through a multidisciplinary deliberation and resolution process, proposes an ethical shared-decision-making model ensuring that dialysis withdrawal follows professional guidelines, and is registered as a method for evaluating professional practice (EPP). Annual activity reports are submitted to the Hospital's Medical Evaluation and Quality Unit. Benefits are individual and collective for patients, relatives and caregivers. Prospects for reducing non-implemented decisions and identifying cases earlier would improve the Committee effectiveness.
authors: University Clinic of Nephrology, DIGIDUNE Pôle, Grenoble, France.
authors: Jocelyne
authors: J
authors: Maurizi Balzan
authors: University Clinic of Nephrology, DIGIDUNE Pôle, Grenoble, France.
authors: Jean Charles
authors: JC
authors: Cartier
authors: University Clinic of Nephrology, DIGIDUNE Pôle, Grenoble, France.
authors: Silvia
authors: S
authors: Calvino-Gunther
authors: University Clinic of Nephrology, DIGIDUNE Pôle, Grenoble, France.
authors: Pierre Louis
authors: PL
authors: Carron
authors: Psychiatry, Neurology and Psychiatry Pole, University Hospital, Grenoble, France.
authors: Patrice
authors: P
authors: Baro
authors: AGDUC (Grenoble's Association for Chronic Uremic Dialysis, La Tronche, France.
authors: Pedro
authors: P
authors: Palacin
authors: University Clinic of Nephrology, DIGIDUNE Pôle, Grenoble, France.
authors: Paul
authors: P
authors: Vialtel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making / Q000941:ethics*; D005260:Female; D005602:France; D006801:Humans; D033183:Interdisciplinary Communication; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009398:Nephrology / Q000379:methods / Q000639:trends; D010166:Palliative Care / Q000379:methods / Q000523:psychology; D010358:Patient Participation; D006435:Renal Dialysis / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D028761:Withholding Treatment / Q000941:ethics / Q000639:trends
keywords: Chronic kidney disease; Ethics; Evaluation; Palliative care; Professional practice; Withdrawal of maintenance dialysis