Palliative Care in End-Stage Renal Disease

Betty R. Ferrell, PhD, RN


December 04, 2019

The first response is correct. Patients making decisions about discontinuing dialysis need support and clear communication about care options and goals of care. It's important to respect the patient's choices. The social worker might also suggest a conference call with her sons after they have discussed her request with the physician. While depression is common in end-stage renal disease (ESRD) and psychological evaluation is important, the most important principle of care is honoring the patient's choices. Conversations about discontinuing dialysis are difficult, and patients deserve honest communication and the opportunity to share their emotions.

Palliative Care in ESRD

Renal dialysis is a common therapy, due in part to available Medicare reimbursement. While of great benefit in extending life, there is increasing recognition that patients with ESRD—especially the elderly, who comprise a growing number of dialysis patents—experience serious quality-of-life burdens including pain, reduced levels of functioning, depression, and significant burden on family caregivers.

At the same time, there is a growing awareness of the benefits of palliative care consultation and referral to hospice for patients with ESRD. As patients make treatment decisions, palliative care provides psychosocial and spiritual support, aggressive symptom management, and the opportunity for a peaceful death, as well as avoidance of hospitalization, intensive care stays, or final days dominated by severe symptoms and distress.


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