A Survey on End-of-Life Contemplation Among Patients on Dialysis

IntroductionAs mortality in dialysis patients is high it would be advisable for patients, relatives and care givers to acknowledge that after dialysis initiation for many patients the last phase in life has begun.We sought to investigate the frequency of precautionary planning (PP) directives, contemplation about the end of life (EOL) and embedding of patients' wishes in the interaction with relatives and the treating nephrologists.MethodsIn a questionnaire-based interview survey, we investigated frequency of PP, EOL wishes and frequency of relatives' or medical professionals' conversations with patients about those wishes as well as possibly associated demographic, socio-economic and medical factors. The interviews were conducted by a single investigator in seven dialysis centers in Germany.ResultsFrom 349 identified patients, 268 participated (77%). The participants (36% female) had a median age of 70 years old (IQR 58-80 years) and had spent a median of 3 years on dialysis (IQR 1-7,5 years). Overall, 46% of dialysis patients contemplate about their EOL wishes at least occasionally. Of those, 85% talked about EOL wishes with their relatives, while 19% discussed them with their nephrologists, yet another 28% would like to have such a discussion with their nephrologist.ConclusionAlmost half of dialysis patients contemplate about their EOL and the vast majority engage in discussions about that with their relatives. However, despite patients being interested, the frequency of consultation of nephrologists on EOL care is low. This study suggests that there is a substantial but unmet need for EOL care consultation in dialysis patients.