Results of Intervention to Increase Goals-of-Care Conversations in Dialysis Centers (SCI950)

Abstract

Objectives: 1 Describe the Pathways Project’s evidence-based change package for kidney supportive care 2 Describe the Results of implementation of goals of care conversations into dialysis center workflow Background: Many dialysis patients receive unwanted high intensity end-of-life care Their families rate the quality of this care lower than families of patients with other chronic diseases At baseline, seriously ill (SI) patients rated communication with dialysis teams very poorly Research Objectives: The purpose of this study was to test the feasibility of an evidence-based intervention to identify SI patients, engage them in goals-of-care conversations (GOC), and track outcomes to see if aligned with patient preferences Methods: Researchers recruited 10 dialysis centers with 1,544 patients Dialysis staff screened patients monthly with the surprise question— Would I be surprised if this patient died in the next 6 months? —to identify SI patients and conduct GOC with them Recorded patient outcomes included number screened, number SI, GOC, hospitalizations, hospice referral, death, and place of death An odds ratio of SI versus non-SI dying, and a Cochran-Armitage trend test were used to assess for increasing GOC and deaths at home The study was interrupted at 9 months due to COVID-19 Results: On average, 98 8% of patients were screened monthly, and 18 4% were identified as SI Of 114 patients who died, SI constituted 66% of deaths The mortality for SI was 27% versus 3% for non-SI, and the odds ratio for SI dying was 11 22 (95% CI 7 42 to 16 98, P < 0001) Dialysis interdisciplinary teams implemented site-specific approaches to adding GOC into usual workflow;the number conducting GOC with SI within 30 days of hospital discharge increased from 30% to 80% (P= 02) Patients dying at home increased (32 6% vs 18 8%), but the trend was not yet significant (P= 12) Conclusion: It is feasible and useful to identify SI dialysis patients After 9 months more dialysis centers were conducting GOC with them Implications for Research, Policy, or Practice: Future research is needed to determine if the intervention increases outcomes more aligned with patient preferences