Palliative Care in the Advancing American Kidney Health Initiative: A Call for Inclusion in Kidney Care Delivery Models.
Palliative Care in the Advancing American Kidney Health Initiative: A Call for Inclusion in Kidney Care Delivery Models.
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DOI：
10.1053/j.ajkd.2020.07.022
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发表时间：
2020-12
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--
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推进美国肾脏健康（AAKH）倡议旨在通过改善肾衰竭治疗选择的可及性和质量，促进以患者为中心的高价值护理。该倡议的3个明确目标是减少肾衰竭的发生率，增加可供移植的肾脏数量，增加移植和家庭透析。为了确保以患者为中心的家庭透析方式，姑息治疗的可行原则，包括系统的沟通和定制的治疗计划，应纳入本政策。从这个角度来看，我们描述了通过姑息治疗加强AAKH计划以患者为中心的两个机会：（1）在终末期肾病治疗选择模型中，所有透析启动都需要进行严重疾病对话，（2）保守肾脏管理应与腹膜透析和家庭血液透析一起被视为家庭模式。一个严重的疾病对话可以帮助临床医生辨别是否患者的目标和价值观是最好的家庭透析方式尊重或非透析策略，如保守的肾脏管理应考虑。一个密集和仔细的以患者和家庭为中心的选择过程将是必要的，以确保没有患者被迫放弃传统的透析。
The Advancing American Kidney Health (AAKH) Initiative aims to promote high-value patient-centered care by improving access to and quality of treatment options for kidney failure. The 3 explicit goals of the initiative are to reduce the incidence of kidney failure, increase the number of available kidneys for transplantation, and increase transplantation and home dialysis. To ensure a patient-centered movement toward home dialysis modalities, actionable principles of palliative care, including systematic communication and customized treatment plans, should be incorporated into this policy. In this perspective, we describe 2 opportunities to strengthen the patience-centeredness of the AAKH Initiative through palliative care: (1) serious illness conversations should be required for all dialysis initiations in the End-Stage Renal Disease Treatment Choices model, and (2) conservative kidney management should be counted as a home modality alongside peritoneal dialysis and home hemodialysis. A serious illness conversation can help clinicians discern whether a patient’s goals and values are best respected by a home dialysis modality or whether a nondialytic strategy such as conservative kidney management should be considered. An intensive and careful patient- and family-centered selection process will be necessary to ensure that no patient is pressured to forego conventional dialysis.
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