Integrating Advance Care Planning Within the Psychosocial Care of Nephrology Patients

Abstract

Persons with end-stage kidney disease (ESKD) are at increased risk for multiple health complications, including increased hospitalizations and shortened life expectancy. These health risks elevate the urgency to complete an advance directive (AD), allowing patients to express their wishes if they are unable to because of limited capacity. Dialysis social workers are well-positioned to skillfully lead these conversations and respond to emotional distress, family conflict and pain, and symptom burden that many persons with ESKD experience. This paper outlines a framework for dialysis social workers to assess the wishes of patients in the event of worsening health and offers suggestions for interventions when patients and family members experience distress related to serious illness and advance care planning (ACP).