Given that individuals on dialysis have a mortality rate significantly higher than the general population,[2] ACP is equally relevant to those who choose who renal replacement therapy and those who opt for supportive care. Advance Veliparib cost Care Planning

may also result in the formulation of Advance Directives (AD) and/or the appointment of a legally nominated substitute decision-maker. AD are statements (usually written but can be oral in some jurisdictions) by an individual indicating their preference for or against a specific medical treatment, for example cardiopulmonary resuscitation or dialysis, in a specific circumstance.[3] The section by Stewart and Brennan ‘Legal issues concerning withholding and withdrawal of dialysis’ discusses AD and substitute decision-makers in more detail. While the treating doctor may not be legally nominated as the substitute decision-maker, an individual may choose to indicate in their ACP that they would like Doramapimod cell line to follow the medical recommendations of their doctor(s) in the event of loss of decision-making capacity or other more specific circumstance. When discussion of renal replacement therapy options results in the choice of conservative (non-dialysis) therapy there is an obvious opportunity to explore the patient’s goals for

quality of life and how medical care can best serve these goals. ACP at this point Urease provides an opportunity to explore the understanding of the patient and family about the prognosis for conservatively managed chronic kidney disease, accommodating the comorbidities of the individual. Information about the possibility of functional decline can facilitate appropriate contingency planning should the patient’s current living situation not meet their future care needs. It is also an opportunity to build a common understanding with the patient and family of when it would be appropriate to withhold or withdraw other life sustaining treatments in the context of terminal care for their kidney disease. End-of-life wishes are more

likely to be known and followed when individuals have been through the ACP process.[4] Aggressive medical care near death in the setting of terminal illness has been shown to reduce patient quality of life in the last week of life.[5] Cognitive impairment, and potentially loss of ability to make decisions about ones care, is common at the end of life meaning that if the patient is to participate in decisions about limiting treatment this often needs to be discussed in advance of the terminal phase of care.[6] ACP can increase patient satisfaction with medical care.[4] Feelings of isolation and lack of hope may be experienced with individuals are not able to honestly and openly discuss their hopes and fears for the future with loved ones.[7] ACP provides an opportunity to ameliorate these feelings by starting discussion.