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S 06 Parallel Session
Programme of the Session
Title:Ethical Issues in renal care
GS: Francesco Locatelli (Italy)
Ethical dilemmas in renal aging
O 05
Empathy assessment in the healthcare professionals of the nephrology and dialysis
Claudio Squarcia (Italy)
O 06
Kidney transplant in a noncompliant young adult – as case study
Raisa Rahmanov (Israel)
O 07
Mental healing after acute rejection – a disregarded issue
Andrea Paar (Hungary)
O 08
Australian patient views: the impact of dialysis treatment and gaps in education and support
Debbie Fortnum (Australia)
Abstracts
GUEST SPEAKER
Ethical dilemmas in renal aging
F. Locatelli1
1Department of Nephology and Dialysis, Alessandro Manzoni Hospital Lecco Italy
The potential burdens of haemodialysis for older patients with significant comorbidities, is increasingly recognized as an hot topic. Greater recognition that health care financial resources are limited makes fair allocation more pressing, highlighting the importance of distributive justice. However we should be aware of the great risk that with the advent of accountable care and bundled payment in some countries, including United States, previous incentives to offer haemodialysis to as many patients as possible are being replaced with a disincentive to dialyze high-risk patients. It is true that as medical technology evolves, a comprehensive understanding of an ethical framework for evaluating appropriate use of medical interventions is mandatory. However while we should avoid the harm of overtreatment for elderly patients with comorbidities, there are concerns that we could return to rationing haemodialysis. In light of the recent emphasis on patient-centered outcomes and quality of life for patients, the importance of patient preferences and personal values should be of paramount in medical decisions, reflecting a focus on the principle of patient autonomy. Nephrologists and nurses are called on to help patients make their decision and should ensure that the patient is correctly informed about the potential benefits and burdens of haemodialysis, including age and all the comorbidities potentially affecting the balance between benefits and burdens. Patients care more about how they will live instead of how long.
BIOGRAPHY OF THE GUEST SPEAKER
O 05
Empathy assessment in the healthcare professionals of the nephrology and dialysis
C. Squarcia1, D. Narcisi1, S. Norcini1, L. Rossi1, A. Tancredi1
1Area Vasta 5 Ascoli Piceno e San Benedetto del Tronto, U.O.C. di Nefrologia e Dialisi, Ascoli Piceno, Italy
Background
The ability to empathise is considered a fundamental attitude of healthcare professionals. In particular, chronic diseases such as uraemia have a deep impact on the life of people.
Objectives
This paper aims at assessing the empathic attitude of healthcare professionals of the Nephrology and Dialysis U.O.C. (Complex Operative Unit) of Area Vasta 5, Italy.
Methods
In our observational study, the official Italian version of the Balanced Emotional Empathy Scale, in order to assess their empathic attitude, was used. The difference in empathy among male and female professionals and among age groups was assessed. 5 facets derived from the sum of responses per item group were assessed too.
Results
The level of empathic attitude resulted to be good; however, female healthcare professionals scored higher in empathic attitude. The empathic attitude of older professionals,both male and female, scored higher than the younger age group. The score results were in line with the national and international average empathic attitude data, both in absolute and category values.
Conclusion/Application to practice
Despite the observational study being carried out in a relatively narrow population, it enabled us to assess our empathic attitude in the professional.The ultimate goal is that the study leads to organise discussion groups and educational actions among healthcare professionals, led by a relationship dynamics expert and aimed at improving complex relationship management.
O 06
Kidney transplant in a noncompliant young adult – as case study
R. Rahmanov1, R. Shternshus1, E. Golland2, J. Barry2, I. Weissman1
1Children Dialysis department, Galilee Medical Center, Naharia, Israel; 2Dialysis department, Galilee Medical Center, Naharia, Israel
Background
Kidney transplant is the treatment of choice in ESRD, in particular for young patients. Post-transplant care requires meticulous adherence to medications. Literature shows poor prognosis of graft survival when there is suboptimal adherence to treatment before transplant, especially when patients have addictions to drugs or alcohol.
A 19 year old male started haemodialysis in January 2014. After starting dialysis he adopted various high risk behaviors: using drugs, driving without a license, surfboarding and skateboarding, not complying with medical instructions and missing some dialysis treatments. He did not have the structure of school or a job. The patient requested a kidney transplant in order to improve his quality of life.
Objectives
Determining whether it is morally correct to transplant this young adult.
Methods
Interviewing young adult , his family, the staff and bringing the case before the hospital ethical committee.
Results
After interviewing him and explaining the importance of non risk behaviors and compliance, he began to come to more dialysis sessions and began to change his behavior, it was therefore decided that he was suitable for transplantation
Now, six months after the transplant the patient comes to routine visits to the post-transplant clinic. Creatinine levels are between 1.07 to 1.15, and he adheres to immunosuppressive therapy. Prograf levels are maintained as required.
Conclusion/Application to practice
Despite the correlation in literature of noncompliance and poor prognosis of graft survival, our results indicate that there is a moral basis for kidney transplant in a young adult with a supporting family and the desire and ability to change behavior.
O 07
Mental healing after acute rejection – a disregarded issue
A. Paar1, L. Ledo1, B. Kiss-Suranyi2, M.D. Ónody1
1Dialysis, B. Braun Avitum Dialysiscentre No. 11, Gyor, Hungary; 2Clinical Research, ICON Plc., Budapest, Hungary
Background
A 49 year old male patient underwent an unsuccessful kidney trasnplantation two times (10.2012, 10.2014). Rehabilitation after rejection caused a significant mental stress for the patient and for the relatives as well.
Objectives
Restarting dialysis after acute rejection means a mental and somatic stress for the patients. We consider rejection as acute when it happens less than 21 days after trasnplantation. This event is particular, according to the medical staff. Patients should be put in condition to process the fail and create a new hope.
Methods
We wondered what kind of determinant facts caused considerable problems in this unexpected situation. We decided to investigate the circumstances that helped the patient to overcome this challenge.
Results
Rehabilitation after acute rejection usually consists of only somatic rehabilitation. There is not dedicated medical staff to help patients in their mental healing. We found that dialysis could be acceptable again but as a long term aim it will be a persistent problem after many trasplantation failure. As for the patients’ personal opinion, it is worth noting that family members are totally disregarded although this could be the most determining feature in this process.
Conclusion/Application to practice
We mustn’t forget the incontestable role of the family in mental healing. The family could assisst most patients, helping them to overcome this experience. We think psychologists would be necessary in the dialysis centres, if not even at the transplantation clinic.
O 08
Australian patient views: the impact of dialysis treatment and gaps in education and support
D. Fortnum1, M. Ludlow2
1Education, Kidney Heath Australia, Perth, Australia; 2Health outcomes, Kidney Health Australia, Perth, Australia
Background
In Australia it is acknowledged that dialysis has a huge treatment burden, even for home dialysis. However there is little data on the impact and whether patients receive enough education and support.
Objectives
To determine the opinions of Australians on all modalities of dialysis about education received, support (both provided and unmet needs) and the impact of dialysis on lifestyle factors.
Methods
A 39 question multi-choice survey was developed with consumer consultation. Following ethics approval it was distributed to all modalities of dialysis patients at 46 randomly selected units across Australia.
Results
1021 responses were received. 74% were satisfied with being on dialysis. Receiving over two hours of education was associated with being on home dialysis (p<0.001). Education delivery needs were more time with health care professionals (28%), more patient contact (24%) and simpler explanations/photos (23%). The top three lifestyle impacts were taking holidays (64%), social events (53%), and ability to participate in sport, varying by modality of dialysis. Financial strain was highest in those under 45yrs (p<0.001). More support was desired in many areas; financial (28%); transport (20%); information about exercise (18%) and help with housework and shopping (16%). Both centre based and home dialysis patients involved carers equally in supporting their dialysis (64%) with 27% receiving a government carer payment.
Conclusion/Application to practice
In Australia all modalities of dialysis had a negative lifestyle impact which was often higher in younger consumers, and also impacted on family life. There were gaps in education and support that could be addressed.