Chronic kidney disease (CKD) is characterized by high symptom burden and poor life expectancy at advanced stage. An integrated approach to timely advance care planning (ACP) and palliative care spanning the CKD care continuum is needed.

Acknowledging the needs and importance of delivering quality palliative care for patients with kidney disease, an expert panel was formed to develop an evidence-based framework that articulates four pillars of palliative care: patient identification, ACP, symptom assessment & management, and care of the dying patient and bereavement. Champions from the five regional renal programs led to the local implementation of the Framework. Education and support tools were developed provincially to facilitate uptake and capacity building among frontline care providers. Environmental scan was conducted to verify progress and needs. Furthermore, a minimal set of quality indicators were developed with patients and health care professionals to assess both processes and outcomes essential for each of the core areas of palliative care to guide strategic planning and continuous quality improvement. 

Environmental scan shows that its implementation varies across the renal programs with each having formalized strategies to facilitate ongoing growth in palliative care. Specifically, prominent improvements were shown in symptom care & management and advance care planning. Key challenges identified include enabling the organizational culture, sustaining quality palliative care and continual improvement. 

A series of provincial strategies over the past decade enabled the culture change in nephrology practice for an integrated palliative care approach to CKD care. Routine reporting of quality indicators supports population-based monitoring of progress and continual improvement in palliative care for those living with kidney disease.

Mobilizing Culture Change for Quality Palliative Care in Patients with Chronic Kidney Disease in British Columbia