title: Unmet Supportive Care Needs in U.S. Dialysis Centers and Lack of Knowledge of Available Resources to Address Them.
abstract: BACKGROUND
  Because of high symptom burden, numerous comorbidities, and shortened life expectancy, dialysis patients are increasingly recognized as appropriate candidates for early and continuous supportive care.
  
  
  OBJECTIVE
  The objectives of this study were to describe dialysis professionals' perceptions of the adequacy of supportive care in dialysis centers, barriers to providing it, suggestions for improving it, and familiarity with the existing evidence-based resources for supportive care of dialysis patients.
  
  
  METHODS
  The Coalition for Supportive Care of Kidney Patients conducted an online survey of dialysis professionals and administrators solicited through the 18 End-Stage Renal Disease Networks and the Renal Physicians Association.
  
  
  RESULTS
  Only 4.5% of 487 respondents believed their dialysis centers were presently providing high-quality supportive care. They identified bereavement support, spiritual support, and end-of-life care discussions as the top three unmet needs. They reported that lack of a predictive algorithm for prognosis was the top barrier, and "guidelines to help with decision-making in seriously ill patients" was the top priority to improve supportive care. A majority of respondents were unaware that an evidence-based validated prognostic model and a clinical practice guideline to help with decision-making were already available.
  
  
  CONCLUSIONS
  Dialysis professionals report significant unmet supportive care needs and barriers in their centers with only a small minority rating themselves as competently providing supportive care. There is an urgent need for education of dialysis professionals about available supportive care resources to provide quality supportive care to dialysis patients.
authors.affiliation: Department of Statistics, West Virginia University, Morgantown, West Virginia, USA.
authors.forename: Stacey
authors.initials: S
authors.lastname: Culp
authors.affiliation: Daleview Associates, Silver Spring, Maryland, USA.
authors.forename: Dale
authors.initials: D
authors.lastname: Lupu
authors.affiliation: Daleview Associates, Silver Spring, Maryland, USA.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Arenella
authors.affiliation: Mid-Atlantic Renal Coalition, Richmond, Virginia, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Armistead
authors.affiliation: Sections of Nephrology and Supportive Care, West Virginia University School of Medicine, Morgantown, West Virginia, USA. Electronic address: amoss@hsc.wvu.edu.
authors.forename: Alvin H
authors.initials: AH
authors.lastname: Moss
mesh_terms: D001291:Attitude of Health Personnel; D019317:Evidence-Based Medicine / Q000379:methods; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education / Q000523:psychology*; D006297:Health Services Accessibility; D006801:Humans; D010166:Palliative Care / Q000379:methods / Q000523:psychology*; D006435:Renal Dialysis / Q000379:methods / Q000523:psychology*; D013727:Terminal Care / Q000379:methods / Q000523:psychology*; D014481:United States
keywords: Supportive care; dialysis center; dialysis patients; education; guidelines; supportive care consultation