Palliative care is comprehensive, interdisciplinary care focusing on pain and symptom
management, advance-care planning and communication, psychosocial and spiritual support,
and, in end-stage renal disease (ESRD), the ethical issues in dialysis decision making.
End-of-life care is one aspect of palliative care and incorporates all of the previously
mentioned components as well as hospice and bereavement care. ESRD patients and their
families are appropriate candidates for palliative care because of their high symptom
burden, shortened survival, and significant comorbidity. The usual pattern of illness
trajectory in ESRD is a progressive decline punctuated by episodes of acute deterioration
prompted by sentinel events like limb amputation or myocardial infarction. Such events
provide opportunities for advance-care planning and communication between providers
and patients and families. Although communication is an integral component of palliative
care, little is understood about effective provider-patient communication, especially
in estimating and discussing prognosis. Palliative care has much to offer toward improving
the quality of dialysis patients’ lives as well as planning for and improving the
quality of their deaths. The palliative care issues of illness trajectory, communication,
and hospice use among ESRD patients will be reviewed.
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© 2007 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
