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Advance care planning with patients who have end-stage kidney disease: A systematic realist review

O'Halloran, Peter; Noble, Helen; Norwood, Kelly; Maxwell, Peter; Shields, Joanne; Fogarty, Damian; Murtagh, Fliss; Morton, Rachael; Brazil, Kevin

Authors

Peter O'Halloran

Helen Noble

Kelly Norwood

Peter Maxwell

Joanne Shields

Damian Fogarty

Rachael Morton

Kevin Brazil



Contributors

Abstract

Context
Patients with end-stage kidney disease have a high mortality rate and disease burden. Despite this, many do not speak with health care professionals about end-of-life issues. Advance care planning is recommended in this context but is complex and challenging. We carried out a realist review to identify factors affecting its implementation.

Objectives
The objectives of this study are 1) to identify implementation theories; 2) to identify factors that help or hinder implementation; and 3) to develop theory on how the intervention may work.

Methods
We carried out a systematic realist review, searching seven electronic databases: Medline, Embase, CINAHL, PsycINFO, Cochrane Library, Google Scholar, and ScienceDirect.

Results
Sixty-two papers were included in the review.

Conclusion
We identified two intervention stages—1) training for health care professionals that addresses concerns, optimizes skills, and clarifies processes and 2) use of documentation and processes that are simple, individually tailored, culturally appropriate, and involve surrogates. These processes work as patients develop trust in professionals, participate in discussions, and clarify values and beliefs about their condition. This leads to greater congruence between patients and surrogates; increased quality of communication between patients and professionals; and increased completion of advance directives. Advance care planning is hindered by lack of training; administrative complexities; pressures of routine care; patients overestimating life expectancy; and when patients, family, and/or clinical staff are reluctant to initiate discussions. It is more likely to succeed where organizations treat it as core business; when the process is culturally appropriate and takes account of patient perceptions; and when patients are willing to consider death and dying with suitably trained staff.

Journal Article Type Review
Publication Date Nov 1, 2018
Journal Journal of Pain and Symptom Management
Print ISSN 0885-3924
Electronic ISSN 1873-6513
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 56
Issue 5
Pages 795-807.e18
APA6 Citation O'Halloran, P., Noble, H., Norwood, K., Maxwell, P., Shields, J., Fogarty, D., …Brazil, K. (2018). Advance care planning with patients who have end-stage kidney disease: A systematic realist review. Journal of pain and symptom management, 56(5), 795-807.e18. https://doi.org/10.1016/j.jpainsymman.2018.07.008
DOI https://doi.org/10.1016/j.jpainsymman.2018.07.008
Keywords Anesthesiology and Pain Medicine; General Nursing; Clinical Neurology
Publisher URL https://www.sciencedirect.com/science/article/pii/S0885392418303476?via%3Dihub

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Copyright Statement
©2018 The authors. Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine. This is an open access article under the CC BY-NC-ND licence.





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