title: Palliative and end-of-life care in nephrology: moving from observations to interventions.
abstract: In comparison with patients who have other serious illnesses, patients with advanced kidney disease have a higher rate of intensive care utilization at the end of life and receive palliative care less frequently. Consensus and clinical practice guidelines have therefore recommended the incorporation of palliative care earlier in the disease trajectory. This review summarizes recent literature on this aspect of care and will highlight future directions for patient-centered care within palliative nephrology.
  
  
  
  Patients with advanced kidney disease and their families frequently do not engage effectively with their clinicians to make informed treatment decisions or plan for care at the end of life. Furthermore, racial and ethnic minority patients continue to receive a lower rate of palliative care services compared to other racial groups. Interventions that promote better palliative care communication and education among nephrology clinicians, patients and their families are becoming increasingly more common in nephrology.
  
  
  
  Overall, improved understanding of the unique care needs of patients with advanced and end-stage kidney disease provides a solid foundation to improve palliative and end-of-life care delivery among diverse populations in nephrology.
authors.affiliation: aDivision of Nephrology, Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School bDepartment of Internal Medicine, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine cDivision of General Medicine, Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Nwamaka D
authors.initials: ND
authors.lastname: Eneanya
authors.forename: Michael K
authors.initials: MK
authors.lastname: Paasche-Orlow
authors.forename: Angelo
authors.initials: A
authors.lastname: Volandes
mesh_terms: D003142:Communication; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000628:therapy*; D009398:Nephrology / Q000592:standards; D010166:Palliative Care / Q000379:methods / Q000592:standards*; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D011368:Professional-Family Relations; D011787:Quality of Health Care; D011788:Quality of Life; D013727:Terminal Care / Q000379:methods / Q000592:standards*