S.TAN1, T.KOH1, E.PANG1, W.L.LOOI1, Y.H.KOH1, S.C.CHIN1, S.C.YEO1
Tan Tock Seng Hospital1
The incidence of chronic kidney disease (CKD) is rising, with patients being older and with multiple co-morbidities. Advance care planning (ACP) helps to align treatment with patient preferences and facilitate shared decision making. We aim to evaluate the impact of ACP on patient-centred outcomes and describe patient preferences expressed during ACP.
We conducted a retrospective cohort study of CKD patients who underwent ACP from 2013 to 2021, comparing outcomes with age-, gender-, aetiology- & renal replacement therapy (RRT) decision-matched patients without ACP. Outcome measures include intensive care unit (ICU) admissions, number of hospitalisations per year, change in decision for renal palliative care (RPC) and need for palliative referral.
198 patients underwent ACP during the study period. Majority of patients elected not for cardio-pulmonary resuscitation (80.8%) or ICU care (77.8%), 9.6% of the cohort changed their mind regarding treatment preferences. In patients who chose RPC, those with ACP were less likely to have a change in decision for conservative management of CKD (8.6% vs 20.2%, p=0.018), fewer hospital admissions a year (1.21 vs 1.92, p=0.001) and reduced need for palliative referral (44.2% vs 61.5%, p=0.013).
ACP should be considered in CKD patients to help align goals of care and treatment preferences.