Nursing staff role can vary between being a patient advocate, and/or a family supporter,[14] as well as participating in ongoing disease management and patient education.[15] Nursing staff need to be equipped with the skills to participate in advanced care planning, in discussions regarding prognosis, end-of-life issues, in evaluating symptoms, and ideally in the use of palliative care assessment tools. Since quality of life (QOL) is subjective, it is paramount that nephrology nurses discuss QOL with patients to determine

what would make a difference to them.[16] Proposed mechanisms includes: Fulvestrant in vitro Training in the use of palliative care tools and palliative care pathways Participation in advance care planning Palliative care module as part of renal nurse training Rotation in a palliative care ward or hospice (Possibly utilizing PEPA) or renal palliative care clinics Support for renal staff for ongoing education in palliative care, e.g. this website palliative care diplomas, palliative care study days Attendance at LCP education days Access to online education for palliative care Access to online guidelines for renal palliative care such as NHS guidelines: http://www.palliativecareguidelines.scot.nhs.uk/symptom…/renal.asp

Liverpool integrated care pathway: http://www.mcpcil.org.uk/liverpool-care-pathway Kidney end-of-life bibliography: http://www.kidneyeol.org/Files/PalliativeCareRefs.aspx St George Hospital Renal Protocols Palliative care: http://stgrenal.med.unsw.edu.au/StGRenalWeb…/Palliative%20Care%20Section Effective delivery of high-quality palliative care requires good inter- professional team-working by skilled health and social care professionals.[17] In order for a multidisciplinary approach to be effective, all team members must be cognizant of their own skills, as well as the skill set of other team members. A study of occupational therapists working in palliative care found that the role of occupational therapy in palliative C-X-C chemokine receptor type 7 (CXCR-7) care is misunderstood; dying people, their carers, some health providers and the wider community did not understand

the potential range of services that could be provided.[18] An audit of Australian tertiary teaching hospitals found that despite 65% of palliative patients presenting with a specific indication for physiotherapy, only 12.8% of these patients were receiving physiotherapy. This highlights the need for education of all disciplines involved in conservative management to ensure the optimum level of care is provided to the patient and their family. Part of palliative management is the attention to ethical, psychosocial and spiritual issues related to end-of life care.[19] Social workers may be particularly helpful in these cases and have a recognized role in advance care planning.[19] Patients’ preference for conservative care is influenced by the availability of subsidized transport and the ability to travel,[20] both factors that may be addressed by social work.