Grant: Project Grant

Frail patients with many chronic illnesses often do poorly on dialysis with rapid decline and poor quality of life. Dialysis is not beneficial for many of these patients and those cared for without dialysis may live as long and better than patients who choose dialysis. The international community advocates for conservative kidney management (CKM) to integrate kidney, primary & palliative care. CKM is aligned with Canadian patient priorities. Unfortunately there are no CKM guidelines and how to implement CKM throughout complex healthcare systems is unknown. This proposal aims to implement & evaluate an innovative CKM Pathway by multidisciplinary providers across Alberta to improve patient outcomes for those who choose CKM while providing better value for money. The CKM Pathway was co-created with patients and a diverse group of knowledge-users. It consists of 1) a Patient Decision Aid (PDA) for dialysis v. CKM and 2) an Integrated Care Plan. The study will evaluated the uptake of CKM and the impact on person-centered outcomes such as satisfaction with care, symptoms, function and quality of life. Processes of care such as advance care planning (ACP), preferred & actual place of care and provider satisfaction will also be evaluated. We anticipate improved satisfaction, symptom control, quality of life and preservation of function. We anticipate more ACP and a shift from acute to community care in concordance with patients' preferences. The PDA will be evaluated for its effectiveness on patients' ability to make informed decisions consistent with their prognosis, values and preferences. We will determine the cost effectiveness of the pathway from health system and caregiver perspectives. Lastly, we will develop national CKM standards and assess facilitators & barriers to the implementation of a CKM pathway nationally within nephrology. This study will set international CKM benchmarks and will serve as a model for pathway development for other complex chronic illnesses