Supporting quality care for ESRD patients: the social worker can help address barriers to advance care planning

Abstract Background Advance Care Planning (ACP) is essential for preparation for end-of-life. It is a means through which patients clarify their treatment wishes. ACP is a patient-centered, dynamic process involving patients, their families, and caregivers. It is designed to 1) clarify goals of care...

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Main Authors: Charles R. Senteio, Mary Beth Callahan
Format: Article
Language:English
Published: BMC 2020-02-01
Series:BMC Nephrology
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12882-020-01720-0
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spelling doaj-e26f2e67b09642acbfb2f8d64e3399d42020-11-25T00:30:55ZengBMCBMC Nephrology1471-23692020-02-012111910.1186/s12882-020-01720-0Supporting quality care for ESRD patients: the social worker can help address barriers to advance care planningCharles R. Senteio0Mary Beth Callahan1School of Communication and Information, Rutgers UniversityDallas Nephrology AssociatesAbstract Background Advance Care Planning (ACP) is essential for preparation for end-of-life. It is a means through which patients clarify their treatment wishes. ACP is a patient-centered, dynamic process involving patients, their families, and caregivers. It is designed to 1) clarify goals of care, 2) increase patient agency over their care and treatments, and 3) help prepare for death. ACP is an active process; the end-stage renal disease (ESRD) illness trajectory creates health circumstances that necessitate that caregivers assess and nurture patient readiness for ACP discussions. Effective ACP enhances patient engagement and quality of life resulting in better quality of care. Main body Despite these benefits, ACP is not consistently completed. Clinical, technical, and social barriers result in key challenges to quality care. First, ACP requires caregivers to have end-of-life conversations that they lack the training to perform and often find difficult. Second, electronic health record (EHR) tools do not enable the efficient exchange of requisite psychosocial information such as treatment burden, patient preferences, health beliefs, priorities, and understanding of prognosis. This results in a lack of information available to enable patients and their families to understand the impact of illness and treatment options. Third, culture plays a vital role in end-of-life conversations. Social barriers include circumstances when a patient’s cultural beliefs or value system conflicts with the caregiver’s beliefs. Caregivers describe this disconnect as a key barrier to ACP. Consistent ACP is integral to quality patient-centered care and social workers’ training and clinical roles uniquely position them to support ACP. Conclusion In this debate, we detail the known barriers to completing ACP for ESRD patients, and we describe its benefits. We detail how social workers, in particular, can support health outcomes by promoting the health information exchange that occurs during these sensitive conversations with patients, their family, and care team members. We aim to inform clinical social workers of this opportunity to enhance quality care by engaging in ACP. We describe research to help further elucidate barriers, and how researchers and caregivers can design and deliver interventions that support ACP to address this persistent challenge to quality end-of-life care.http://link.springer.com/article/10.1186/s12882-020-01720-0Advance care planningEnd-of-life careERD quality care
collection DOAJ
language English
format Article
sources DOAJ
author Charles R. Senteio
Mary Beth Callahan
spellingShingle Charles R. Senteio
Mary Beth Callahan
Supporting quality care for ESRD patients: the social worker can help address barriers to advance care planning
BMC Nephrology
Advance care planning
End-of-life care
ERD quality care
author_facet Charles R. Senteio
Mary Beth Callahan
author_sort Charles R. Senteio
title Supporting quality care for ESRD patients: the social worker can help address barriers to advance care planning
title_short Supporting quality care for ESRD patients: the social worker can help address barriers to advance care planning
title_full Supporting quality care for ESRD patients: the social worker can help address barriers to advance care planning
title_fullStr Supporting quality care for ESRD patients: the social worker can help address barriers to advance care planning
title_full_unstemmed Supporting quality care for ESRD patients: the social worker can help address barriers to advance care planning
title_sort supporting quality care for esrd patients: the social worker can help address barriers to advance care planning
publisher BMC
series BMC Nephrology
issn 1471-2369
publishDate 2020-02-01
description Abstract Background Advance Care Planning (ACP) is essential for preparation for end-of-life. It is a means through which patients clarify their treatment wishes. ACP is a patient-centered, dynamic process involving patients, their families, and caregivers. It is designed to 1) clarify goals of care, 2) increase patient agency over their care and treatments, and 3) help prepare for death. ACP is an active process; the end-stage renal disease (ESRD) illness trajectory creates health circumstances that necessitate that caregivers assess and nurture patient readiness for ACP discussions. Effective ACP enhances patient engagement and quality of life resulting in better quality of care. Main body Despite these benefits, ACP is not consistently completed. Clinical, technical, and social barriers result in key challenges to quality care. First, ACP requires caregivers to have end-of-life conversations that they lack the training to perform and often find difficult. Second, electronic health record (EHR) tools do not enable the efficient exchange of requisite psychosocial information such as treatment burden, patient preferences, health beliefs, priorities, and understanding of prognosis. This results in a lack of information available to enable patients and their families to understand the impact of illness and treatment options. Third, culture plays a vital role in end-of-life conversations. Social barriers include circumstances when a patient’s cultural beliefs or value system conflicts with the caregiver’s beliefs. Caregivers describe this disconnect as a key barrier to ACP. Consistent ACP is integral to quality patient-centered care and social workers’ training and clinical roles uniquely position them to support ACP. Conclusion In this debate, we detail the known barriers to completing ACP for ESRD patients, and we describe its benefits. We detail how social workers, in particular, can support health outcomes by promoting the health information exchange that occurs during these sensitive conversations with patients, their family, and care team members. We aim to inform clinical social workers of this opportunity to enhance quality care by engaging in ACP. We describe research to help further elucidate barriers, and how researchers and caregivers can design and deliver interventions that support ACP to address this persistent challenge to quality end-of-life care.
topic Advance care planning
End-of-life care
ERD quality care
url http://link.springer.com/article/10.1186/s12882-020-01720-0
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