title: Advance care planning in chronic kidney disease: A survey of current practice in Australia.
abstract: OBJECTIVE
  Advance care planning (ACP) in nephrology is widely advocated but not always implemented. The aims of this study were to describe current ACP practice and identify barriers/facilitators and perceived need for health professional education and chronic kidney disease (CKD)-specific approaches.
  
  
  METHODS
  An anonymous cross-sectional survey was administered online. Nephrology health professionals in Australia and New Zealand were recruited via professional societies, email lists and nephrology conferences. Multiple regression explored the influence of respondents' attributes on extent of involvement in ACP and willingness to engage in future.
  
  
  RESULTS
  A total of 375 respondents included nephrologists (23%), nurses (65%), social workers (4%) and others (8%) with 54% indicated that ACP at their workplace was performed ad hoc and 61% poorly. Perceived barriers included patient/family discomfort (84%), difficulty engaging families (83%), lack of clinician expertise (83%) and time (82%), health professional discomfort (72%), cultural/language barriers (65%), lack of private space (61%) and lack of formal policy/procedures (60%). Respondents overwhelmingly endorsed the need for more dialysis-specific ACP programs (96%) and education (95%). Whilst 85% thought ACP would be optimally performed by specially trained staff, comments emphasized that all clinicians should have a working proficiency. Respondents who were more willing to engage in future ACP tended to be non-physicians (odds ratio (OR) 4.96, 95% confidence intervals (CI) 1.74-14.07) and reported a greater need for CKD-specific ACP materials (OR 10.88, 95% CI 2.38-49.79).
  
  
  CONCLUSIONS
  Advance care planning in nephrology needs support through education and CKD-specific resources. Endorsement by nephrologists is important. A multidisciplinary approach with a gradient of ACP expertise is also recommended.
authors: Improving Palliative Care through Clinical Trials (ImPaCCT) New South Wales, New South Wales, Australia.|Faculty of Health, University of Technology Sydney (UTS), Sydney, New South Wales, Australia.
authors: Tim
authors: T
authors: Luckett
authors: Department of Renal Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors: Lucy
authors: L
authors: Spencer
authors: NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia.
authors: Rachael L
authors: RL
authors: Morton
authors: Department of Renal Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.|Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors: Carol A
authors: CA
authors: Pollock
authors: Faculty of Health, University of Technology Sydney (UTS), Sydney, New South Wales, Australia.
authors: Lawrence
authors: L
authors: Lam
authors: Respecting Patient Choices, Austin Health, Melbourne, Victoria, Australia.
authors: William
authors: W
authors: Silvester
authors: Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.|Respecting Patient Choices, Austin Health, Melbourne, Victoria, Australia.
authors: Marcus
authors: M
authors: Sellars
authors: Respecting Patient Choices, Austin Health, Melbourne, Victoria, Australia.
authors: Karen M
authors: KM
authors: Detering
authors: School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.
authors: Phyllis N
authors: PN
authors: Butow
authors: School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
authors: Allison
authors: A
authors: Tong
authors: Improving Palliative Care through Clinical Trials (ImPaCCT) New South Wales, New South Wales, Australia.|Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.|HammondCare Palliative & Supportive Care Service, Greenwich Hospital, Sydney, New South Wales.
authors: Josephine M
authors: JM
authors: Clayton
mesh_terms: D000328:Adult; D032722:Advance Care Planning / Q000639:trends*; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D001315:Australia; D003430:Cross-Sectional Studies; D004502:Education, Medical, Continuing; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007318:Inservice Training; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009398:Nephrology / Q000193:education / Q000639:trends*; D016017:Odds Ratio; D010353:Patient Education as Topic / Q000639:trends; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011368:Professional-Family Relations; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*
keywords: advance care planning; chronic kidney disease; conservative care; current practice; health professional view