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"The right care, to the right patient, at the right time."

 Dr. Sara Davison

Alberta's Provincial Conservative Kidney Management (CKM) Clinical Pathway

 

In partnership with the Kidney Health Strategic Clinical NetworkTM, the Kidney Supportive Care Research Group (KSCRG) has developed, implemented and is now evaluating a province wide conservative kidney management clinical pathway.

The CKM pathway has been developed for patients with end stage kidney failure unlikely to benefit from chronic dialysis and who choose conservative (non-dialysis) care. These patients may live as long as those who decide to start dialysis, while still maintaining a better quality of life.

The pathway coordinates kidney care with relevant primary and palliative care services, and will incorporate new initiatives currently being developed and rolled out under the direction of Alberta Health Services.

It is anticipated that the CKM pathway will reduce the burden on acute care facilities as well as enable quality, efficient, cost-effective and standardized CKM care, regardless of location. The  CKM pathway will also enable greater control for patients and their families to make decisions regarding dialysis or CKM consistent with their values and goals.

The pathway is currently in the implementation phase with on-going evaluation. Clinical results will be available in March 2018.

Information from the pathway aided in the development and implementation of an interactive, web-based, patient decision aid around the appropriate initiation of dialysis.

The CKM pathway is accessible freely at www.ckmcare.com.

This project is funded by Alberta Innovates – Partnership for Research and Innovation in the Health System (PRIHS)

Dr. Sara Davison speaking with patient at dialysis unit

Patient Engagement: the Development and Implementation of an Interactive, Web-based, Patient Decision Aid around the Appropriate Initiation of Dialysis  Versus Conservative Kidney Management

 

Older frail patients with other health problems often experience functional and cognitive decline after starting dialysis and therefore may choose conservative kidney management (CKM).

To better understand the barriers and facilitators to care, the CKM Project Team conducted a series of workshops and surveys in the Fall of 2015 with stakeholders across Alberta, Canada.  Feedback showed that communicating treatment options around either dialysis or CKM to patients is challenging for both healthcare providers and patients/families.

Patient decision aids (PDAs) provide a structured, evidence-based platform for staff to engage patients in these difficult conversations. PDAs have also have been shown to improve patient’s knowledge regarding treatment options, reduce their decisional conflict related to feeling uninformed and unclear about their personal values, enables them to take a more active role in decision-making and improves congruence between the chosen option and their values. PDAs are particularly beneficial when each option has benefits and harms that patients may value differently.

Objectives:

  1. Develop a PDA around the appropriate initiation of dialysis versus CKM based on the International Patient Decision Aid Standards (IPDAS) and the Ottawa Decision Support Framework.
  2. Develop a web based mobile responsive web experience for the PDA for patients and staff.
  3. Implement and evaluate the PDA as a pilot project within the Northern Alberta Renal program through their four Renal Insufficiency Clinics.

This project is funded by Alberta Innovates – Partnership for Research and Innovation in the Health System (PRIHS)

Northern Alberta Renal Program (NARP) Clinical Initiatives

Supportive Care Initiative: Identifying Patients at Risk

Advanced Care Planning (ACP) Initiative

Chronic Pain Assessment and Management Initiative

This initiative deals with the development and implementation of routine and systematic processes to identify all high risk stage 5 chronic kidney disease (CKD) patients most likely to benefit from supportive care interventions (Davison 2011).

This supportive care framework has sparked change across Canada. In addition, the framework and kidney supportive care strategies are being implemented across North America and Europe.

It incorporates sustainable kidney supportive care education for all NARP staff including competency-based ACP skill acquisition and symptom management.

The advanced care planning process is evolving from a document-driven decision focused event to one that emphasizes a patient-centred process focusing on conversations around broader goals of care.

This ongoing initiative involves the intensive skills training of multi-professional ACP facilitators. The project’s focus is on the development and implementation of processes to systematically facilitate ACP for patients most at need within NARP.

The ACP Initiative was designed to complement the provincial rollout of the Goals of Care Designation (GCD). A full QI strategy to evaluate the project has been implemented.

In collaboration with the ACP Collaborative Research and Innovation Opportunities Program (CRIO), we have led the development of new tools to measure patient engagement in the ACP process: the Behaviours in Advance Care Planning and ACtions Survey (BACPACS).

Pain is one of the most commonly experienced and debilitating symptoms of patients with advanced Chronic Kidney Disease (CKD) and is not typically improved by dialysis.

This ongoing project involved the development and implementation of tools and strategies for the routine and systematic assessment and management of chronic pain in patients with advanced CKD.

Comprehensive evaluation is ongoing.

Interested in our Clinical Initiatives? Collaborate With Us!

Vision: To help people enjoy life while living with advanced chronic kidney disease by becoming a world leader in kidney supportive care research and clinical innovation.

Kidney Supportive Care Research Group (KSCRG)  l  Mailing Address: 8-105 Clinical Sciences Building, University of Alberta, 11350 83 Avenue NW, Edmonton, AB, T6G 2G3  l  Email: kscrg@ualberta.ca  l  Phone: (780) 492-0926 l  Fax: (780) 407-8117

Dr. Sara Davison speaking with patient at dialysis unit
Dr. Sara Davison speaking with patient at dialysis unit
Dr. Sara Davison speaking with patient at dialysis unit
Dr. Sara Davison speaking with patient at dialysis unit
Dr. Sara Davison speaking with patient at dialysis unit
Kidney Supportive Care Research Group (KSCRG)
Dr. Sara Davison speaking with patient at dialysis unit
Dr. Sara Davison speaking with patient at dialysis unit

The right care, to the right patient, at the right time.

 Dr. Sara Davison

Dr. Sara Davison speaking with patient at dialysis unit
Dr. Sara Davison speaking with patient at dialysis unit
Dr. Sara Davison speaking with patient at dialysis unit