title: Spirituality in Renal Supportive Care: A Thematic Review.
abstract: Chronic kidney disease is marked by a reduced life expectancy and a high symptom burden. For those who reach end-stage renal disease, the prognosis is poor, and this combined with the growing prevalence of the disease necessitates supportive and palliative care programmes that will address people's psychosocial, cultural and spiritual needs. While there is variation between countries, research reveals that many renal specialist nurses and doctors are reluctant to address spirituality, initiate end-of-life conversations or implement conservative treatment plans early. Yet, other studies indicate that the provision of palliative care services, which includes the spiritual dimension, can reduce symptom burden, assist patients in making advanced directives/plans and improve health-related quality of life. This review brings together the current literature related to renal supportive care and spirituality under the following sections and themes. The introduction and background sections situate spirituality in both healthcare generally and chronic kidney disease. Gaps in the provision of chronic kidney disease spiritual care are then considered, followed by a discussion of the palliative care model related to chronic kidney disease and spirituality. Chronic kidney disease spiritual needs and care approaches are discussed with reference to advanced care planning, hope, grief and relationships. A particular focus on quality of life is developed, with spirituality named as a key dimension. Finally, further challenges, such as culture, training and limitations, are explicated.
authors.affiliation: Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand. richard.egan@otago.ac.nz.
authors.forename: Richard
authors.initials: R
authors.lastname: Egan
authors.affiliation: Department of Preventive &#38; Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand. sarah.wood@otago.ac.nz.
authors.forename: Sarah
authors.initials: S
authors.lastname: Wood
authors.affiliation: Hammond Care and Northern Clinical School, University of Sydney, Sydney 2065, Australia. rmacleod@hammond.com.au.
authors.forename: Rod
authors.initials: R
authors.lastname: MacLeod
authors.affiliation: Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand. rob.walker@otago.ac.nz.
authors.forename: Robert
authors.initials: R
authors.lastname: Walker
keywords: chronic kidney disease; end-of-life; palliative care; religion; renal supportive care; spirituality