Advance care planning for patients with end-stage kidney disease: A local perspective

Ms Wendy Gibson1,2, Mrs.  Bharati Mehta1,3

1Renal Supportive Care – Western Renal Service, Blacktown, Australia, 2Renal Society of Australiasia, NSW, Australia, 3Australian Association of Social Workers, NSW, Australia

ACP is a process of discussions concerning patients’ values, their Goals of Care (GOC) and their End of Life (EOL) wishes.  Ideally, it should involve patients, their families and carers and their professional care providers in a shared decision-making process.  A procedural guideline has been developed to guide staff undertaking ACP for patients with ESKD either receiving Renal Replacement Therapy or on a Conservative Pathway.

The first step of this guideline is to enhance the comfort level of Renal Staff discussing values, GOC and EOL wishes with patients.  It is important to recognise that, even with training, not all staff feel comfortable initiating these discussions.  A referral pathway has been designed so that these staff can refer patients to other clinicians more comfortable in initiating these discussions.

Our goal is to raise the subject of ACP with all patients with ESKD.  A proportion may progress to a written document, an Advance Care Directive (ACD).  At the very least, we aim that patients’ families and carers have insight into their loved ones’ values, GOC and EOL wishes.  ACP and ACDs reduce stress in bereaved relatives.


Wendy Gibson

Wendy has been working in Nephrology since 1998 and has a variety of experience in the field,  since 2002 to 2017 worked in haemodialysis. In 2017 she started working in Renal Supportive Care, and has developed an interest in how the workforce approaches and implements  Advanced Care Planning.

She also has worked as a Clinical Nurse Educator for 7 years in haemodialysis.

Wendy has presented at the Renal Society of Australasia and the Nephrology Educators Network Symposium, she has also a founding member and Board Member of The Nephrology Educators Network.


Bharati Mehta

Bharati is a Renal Supportive Care Senior Hub Social Worker for

Western Renal Services working with patients across western Sydney and Nepean Blue Mountains local health districts since last four years. She has acquired Master’s degree in Social Work, with 25 years of extensive work experience working in the field of Social Work. She is a current member of Australian Association of Social Worker. She has worked as a mental health specialist clinician and with Ageing and Disability in the past.

Patients with end-stage kidney disease (ESKD) experience a high symptom burden and increased morbidity and mortality rates when compared to those with other diagnoses.  Many older patients, especially those with multiple comorbidities, don’t achieve any improvement in function or longevity with Renal Replacement Therapy.  Advance Care Planning (ACP) is often delayed until the approach of the end of life.


The ASM is hosted by Australian and New Zealand Society of Nephrology.

The aims of the Society are to promote and support the study of the kidney and urinary tract in health and disease, and to ensure the highest professional standards for the practice of nephrology in Australia and New Zealand.

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