[Prof Mark Brown discussing the renal supportive care model at St George Hospital]
21-23rd August, 2015 | St George Hospital, Sydney
It was the fifth annual symposium but the first master class. A truly multi-disciplinary audience comprising nephrology, palliative care, geriatrics, trainees, specialists, nurses, social workers, dieticians, et al met on a warm and wet weekend at the St George Hospital in Sydney. All shared a commitment to making life better for individuals with advanced kidney disease.
I learnt heaps:
- It’s common and it’s serious: increasing numbers of patients choose to start dialysis, a equally large ‘hidden population’ of patients do not, they are often faced with a heavy symptom burden and poor outcomes (worse than many cancers)
- Renal supportive care is not ‘second best’ to dialysis, but a ‘thorough, systematic, evidence-based’ alternative
- Nephrologists really care about their patient’s quality of life, but they struggle with things that palliative care clinicians do every day (e.g. facilitating end-of-life care issues); what’s more, they often don’t know what they don’t know: a survey of nephrologists did not think communication skill training important, even though this is one of the most important tools in renal supportive care (along with symptom management, psychosocial support, advance care planning, community and terminal care)
- There are many different models of renal supportive care being developed around Australia & New Zealand, depending on local conditions (people, resources), but having a local nephrology champion & multi-disciplinary team input critical to success
- There is growing evidence- and experience-base for a number of interventions in renal supportive care (e.g. the use of gabapentin or pregabalin for uraemic pruritus)
- ‘Pain etiquette’ from the ever-eloquent Dr Frank Brennan: enquire regularly, respond compassionately, treat competently, refer wisely
Plus a trio of gems from Dr Kat Urban on the final day:
- Diagnosing death is difficult, but often necessary to facilitating a good death; it’s okay to get it wrong
- Resuscitation discussions should always occur as part of a broader discussion about goals of care
- If resuscitation is considered medically futile, it should not be offered as this creates an inappropriate burden of choice
I would highly recommend the weekend to everyone involved in caring for (or researching in) individuals with advanced kidney diseases. Check the St George Renal Service website for updates!