Barriers and Facilitators to Supportive Care for ESRD Dialysis Patients— A Social Worker’s Role

Abstract

Despite efforts to increase supportive care for patients on dialysis, many barriers continue to exist. This study surveyed dialysis facility
staff to examine the barriers and facilitators related to providing supportive care to patients on dialysis. This qualitative analysis revealed five barriers: 1) lack of integrated, holistic teams; 2) practitioner beliefs; 3) perceptions of social work competence; 4) time and
workload; and 5) lack of clarity regarding palliative care versus hospice and interpreting Medicare benefits. The analysis also revealed four facilitators related to providing supportive care: 1) integrated, holistic teams, including family involvement; 2) collaboration across
care teams; 3) communication and compassion; and 4) formal or regular mechanisms for the review of advance-care plans. Based on
the professional ethics code, social workers can play a role in bolstering their own teams’ capacity to integrate supportive-care practices. Further, using their advocacy skills, social workers can lead efforts to ensure that they and their colleagues have appropriate training and competence in supportive care. Finally, social workers, with their knowledge of community resources, can help foster innovative collaboration between dialysis organizations and palliative care and hospice organizations, in spite of current regulatory and financial barriers.