Effects of a Transitional Palliative Care Model on Patients With End-stage Renal Failure

Effects of a Transitional Palliative Care Model on Patients With ESRF

Primary aim:

1. To compare the effects of customary care and an interventional Home-based Palliative Renal Program (HBPRP) for ESRF patients

2. To compare the effects of customary care and Home-based Palliative Program (HBPP) for ESRF patients

   Secondary aim:

3. To explore the lived experiences of patients with ESRF. Hypothesis The transitional renal palliative care model is associated with decreased in unscheduled hospital readmission, reduce length of stay as well as improved quality of life for patients with end-stage renal failure.

Objectives

Related to the primary aim:

1. Are there differences in healthcare utilization between the ESRF patients in the customary care group and those in the HBPRP group; in the HBPRP group and HBPP group?

2. Are there differences in evaluated health outcomes (functional status, symptom intensity, and satisfaction with care) between the customary care group and the HBPRP group ; in the HBPRP group and HBPP group?

3. Are there differences in perceived health outcomes (quality of life, caregiver burden) between the customary care group and the HBPRP group; in the HBPRP group and HBPP group?

   Related to the secondary aim:

4. How are the lived experiences compared and contrasted between the customary care group and the HBPRP group; in the HBPRP group and HBPP group?

Inclusion Criteria:

• Patient with chronic kidney disease and diabetic mellitus with Creatinine ≥350 milli mole (uM) or those without diabetic mellitus with Creatinine ≥450 milli mole (uM) who refused renal replacement therapy (RRT);
• Patient not suitable for long term renal replacement therapy (RRT) after assessment by renal team (e.g. multiple co morbidities, poor functional status and social support)
• Identified as ESRF patient eligible for palliative care without prior renal replacement therapy
• Ability to speak Cantonese
• Living within the hospital service area
• Ability to be contacted by phone

Exclusion Criteria:

• Discharged to nursing home or other institution
• Inability to communicate
• Cognitive impairment, mini mental stage examination (MMSE) < 20
• Diagnosed with severe psychiatric disorders such as schizophrenia and bipolar disorder