Advance care planning in elderly chronic dialysis patients

Despite the usefulness of advance directives,most dialysis patients do not complete them. Current views of the advance care planningprocess emphasize that development of aspecific written advance directive is only onesmall part of the process. Patients andfamilies use advance care planning discussionsto plan for death, achieve control over theirhealth care, and strengthen relationships. Studies of chronic dialysis patients have shownthat discussions about end-of-life care occurwithin the patient–family and not thepatient–physician relationship. Successfuladvance care planning requires that dialysiscare providers incorporate end-of-life carewishes and palliative care into the overallhealth care plans for their patients. Thisreview focuses on the past impediments toachieving useful advance directives amongdialysis patients and their families andprovides some suggestions to improving thisimportant aspect of dialysis patient care.