Renal Palliative Care in WADevelopments & Challenges

Dr Brian Siva

21st August 2015

Perth Metropolitan Area Health Service

RPH

FH/FSH

SCGH

• 80 year old female on hemodialysis• Multiple myeloma with lytic lesions• Spontaneous fractures & pain• Chemotherapy• Desperate to cease dialysis to ‘end it all’

Renal Supportive Care Clinic

Fremantle Hospital2013

• Commenced April 2012• Staff – nephrologist, CKD nurse, palliative care nurse, social worker• Fortnightly• Clinic based service• Referrals from nephrologists, nurses, dialysis units• Information: posters, emails, RSA meeting• Meeting with head of Silverchain Palliative care• Presentation at the WA palliative care education night

• Nephrologist - - Symptom management & Medication review - Prognosis and advanced health directives discussion - NFR status

• Palliative Care CNC - Introduce palliative care concepts - Introduce advance healthcare directives - referral to community palliative care - PCOC assessment, Symptom score

• CKD Nurse (CNS) - Discuss current kidney function - Quality of life (assessment) - Withdrawal from dialysis - Preparations for end of life planning

2012

Dialysis patients deaths 2012-2014

• Challenges: - patient recruitment into clinic - clinic vs service model - clinics were too long - advanced care planning

Encouragement :- our presence was noticed- links to regional palliative care services set-up

FSH Renal Supportive Care clinic

-Started Feb 2015-Nephrologist, CKD nurse-Single clinic-Data collection-ACP -Mandatory for all conservative care patients

What the future holds:

• More advanced care planning• Palliative care involvement • Recruitment of dialysis patients (RPA 2010) – ACP, symptoms Ax• Separate inpatient service for care of the dying• Extension to regional/rural WA - telehealth

Conclusions• Role of palliative care recognised• Renal Palliative Care pathway 2012• FH & FSH model• 2 main hurdles – funding and resources

Thank you

“Although never easy, dying has been getting harder. Yes, it's harder to die because doctors can now diagnose and

cure many more ills. But death is also harder on the patient because now we die from the debilitating, life-sucking long-

term diseases”

Acknowledgements

Sandie Porter, CKD NurseJohn Robinson, Palliative care CNC

Renal Service, FSHLiz, Frank and Mark (St George)