Authors (including presenting author) :
Li YN (1), Yuen SK (2), Lee NY Leonard (1), Yeung SK Vicky (1)
Affiliation :
(1) Department of Medical Social Services, Caritas Medical Centre (2) Department of Medicine & Geriatrics, Caritas Medical Centre
Introduction :
Medical treatment decisions for patients suffering from end stage kidney disease (ESKD) must be made based on patients’ best interest after considering the risks and perceived burdens of all treatment options. Renal advance care planning (ACP) is a proactive communication process among patients, their care givers and the medical team; aiming at formulating a holistic management plan of ESKD. Information giving remains as a vital foundation for subsequent ACP discussion, based on patients’ past experiences and personal values. Renal ACP should be tailor-made to each client, it is thus very time consuming for a quality ACP could never be done in haste. Since a typical first ACP interview lasts for more than an hour, service sustainability was a problem with the tight manpower and rising service demand.
Objectives :
To better balance between quality and efficiency, the renal unit multidisciplinary meeting decided to save work hours by adopting a hybrid renal ACP mode. Factual information would first be delivered by video-broadcasting. Quality was maintained by subsequent facilitation led by a nephrologist.
Methodology :
ACP participants (patients ± caregivers) viewed the 23-minutes video after an introduction by a medical social worker (MSW). This comprehensive, precise, fact-delivering video was recorded by two nephrologists and a medical social worker and included sessions that covered general knowledge, treatment options, community resources and financial support. When the video broadcast ended, the duty renal physician and MSW seated in and continued the renal ACP process. This might involve clarification of medical progress, filling of knowledge gap, exploration of personal values, provision of realistic options and facilitation to make the final decision. Patients completed a 13-items questionnaire to evaluate this new ACP model.
Result & Outcome :
From 27 Aug 2021 to 29 Oct 2021, thirty ACP participants (25 male, 5 female), aged 68.73 years (standard deviation 11.16) attended the renal ACP. The post-video facilitation process lasted for a median of 26.5 minutes (range 8 to 45). All the participants strongly agreed the pre-recorded video delivered information clearly, saved time and markedly facilitated subsequent discussion with the medical team. The new renal ACP ensured service sustainability by improving efficiency.
