#2266 Integrating palliative care into nephrology: a single-center “action-research” process

Abstract Background and Aims Recognizing the need to integrate palliative care into nephrology, an “action-research” model was launched in April 2023. Method A multidisciplinary pilot group (6 nephrologists, 7 nurses), led by a psychologist, was established and operated through seven focus groups to explore perceived challenges, training needs, and potential strategies for integrating palliative care into clinical practice. The model employed was an “action-research” one, model characterised by a cyclical process of inquiry, action, and reflection, where data is collected, analysed, and used to inform and to promote empowering collaboration to needed change. The discussions were transcribed and analysed manually (“paper and pencil”). Based on the main themes/topics that emerged, a questionnaire was administered to all nephrologist and nurses of the unit. The questionnaire included four Likert scale questions (1 = not at all, 5 = very much), one multiple-choice question, and one open-ended question, aiming to identify perceived barriers and resources for implementing palliative care. The answers of the open-ended question were analysed using the T-Lab software. The findings informed the creation of a teaching initiative for all the unit staff. Additionally, the number of patients referred to palliative care pathways before and after the initiative was started was recorded to quantify its impact. Results The content analysis of the seven focus groups revealed the need to challenge stereotypes about palliative care and to develop tools for timely activation of palliative care pathways. Key findings included characteristics of palliative care patients (psychological suffering [6/10 participants] and physical suffering [4/10 participants]); highly relational tasks (10/10 participants) for nurse-physician roles in order to support patients and families in a flexible decision-making process. These insights informed the development of a questionnaire distributed to all the unit staff. A total of 114 out of 205 staff members (55%) participated, comprising 77 nurses (68%) and 37 doctors (32%). The findings showed that 66% of respondents considered palliative care “very important”, but 38% felt it was only “fairly” achievable. 62% agreed that palliative care is a “shared treatment pathway”. 31% believed patients were “minimally involved” in decision-making, while 90% felt family members were “quite” or “very involved”. Thematic analysis identified four key clusters (Fig. 1). Those were classified as “Need for a culture in palliative care” (38% of variance), highlighted primarily by doctors, who cited lack of experience and resources as major barriers. “Patient centered care” (35% of variance), emphasized by nurses. “Necessary approaches” (17% of variance). “Dignified death” (11% of variance). Following the questionnaire, the pilot group organized for all the unit staff a teaching day on the clinical, psychological and ethical challenges of palliative care, involving palliative care specialists and ethicists. As a measure of the overall initiative impact, patient referrals to palliative care before and after the initiative were compared: in the 390 days before the integration process, 30 patients were referred (26 in the acute settings); in the 390 days following the start of the initiative, 73 patients were referred (61 in the acute settings). Conclusion The overall initiative significantly increased awareness of palliative care as an integral treatment option. For the Nephrology Unit, palliative care is viewed as a valuable resource for supporting patients and families at the end of life. However, limitations remain, particularly in terms of experience and resources. From this perspective, a close integration between palliative care specialists and nephrologists is required in order to activate processes for simultaneous care and reduce the number of referrals in the acute setting.

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