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Creating KidneyPal: A Specialty-Aligned Palliative Care Service for People with Kidney Disease

  • Author Footnotes
    ⁎ Co-First Authors.
    Joshua R. Lakin
    Correspondence
    Address correspondence to: Joshua R. Lakin, MD, 450 Brookline Ave. Boston, MA 02215.
    Footnotes
    ⁎ Co-First Authors.
    Affiliations
    Division of Palliative Medicine (J.R.L., K.S., R.L., S.G., J.A.T), Brigham and Women's Hospital, Boston, Massachusetts

    Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.R.L., K.S., R.L., K.K., S.G., J.A.T, S.N.Z., T.W.), Boston, Massachusetts

    Harvard Medical School (J.R.L., R.L., S.G., J.A.T, E.I.M.), Boston, Massachusetts
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  • Author Footnotes
    ⁎ Co-First Authors.
    Kate Sciacca
    Footnotes
    ⁎ Co-First Authors.
    Affiliations
    Division of Palliative Medicine (J.R.L., K.S., R.L., S.G., J.A.T), Brigham and Women's Hospital, Boston, Massachusetts

    Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.R.L., K.S., R.L., K.K., S.G., J.A.T, S.N.Z., T.W.), Boston, Massachusetts
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  • Richard Leiter
    Affiliations
    Division of Palliative Medicine (J.R.L., K.S., R.L., S.G., J.A.T), Brigham and Women's Hospital, Boston, Massachusetts

    Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.R.L., K.S., R.L., K.K., S.G., J.A.T, S.N.Z., T.W.), Boston, Massachusetts

    Harvard Medical School (J.R.L., R.L., S.G., J.A.T, E.I.M.), Boston, Massachusetts
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  • Kelsey Killeen
    Affiliations
    Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.R.L., K.S., R.L., K.K., S.G., J.A.T, S.N.Z., T.W.), Boston, Massachusetts
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  • Samantha Gelfand
    Affiliations
    Division of Palliative Medicine (J.R.L., K.S., R.L., S.G., J.A.T), Brigham and Women's Hospital, Boston, Massachusetts

    Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.R.L., K.S., R.L., K.K., S.G., J.A.T, S.N.Z., T.W.), Boston, Massachusetts

    Harvard Medical School (J.R.L., R.L., S.G., J.A.T, E.I.M.), Boston, Massachusetts

    Division of Renal Medicine, Brigham and Women's Hospital (S.G., E.I.M.), Boston, Massachusetts
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  • James A. Tulsky
    Affiliations
    Division of Palliative Medicine (J.R.L., K.S., R.L., S.G., J.A.T), Brigham and Women's Hospital, Boston, Massachusetts

    Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.R.L., K.S., R.L., K.K., S.G., J.A.T, S.N.Z., T.W.), Boston, Massachusetts

    Harvard Medical School (J.R.L., R.L., S.G., J.A.T, E.I.M.), Boston, Massachusetts
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  • Shelly Anderson
    Affiliations
    Brigham and Women's Hospital (S.A.), Boston, Massachusetts
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  • Sophia N Zupanc
    Affiliations
    Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.R.L., K.S., R.L., K.K., S.G., J.A.T, S.N.Z., T.W.), Boston, Massachusetts
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  • Trey Williams
    Affiliations
    Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.R.L., K.S., R.L., K.K., S.G., J.A.T, S.N.Z., T.W.), Boston, Massachusetts
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  • Ernest I. Mandel
    Affiliations
    Harvard Medical School (J.R.L., R.L., S.G., J.A.T, E.I.M.), Boston, Massachusetts

    Division of Renal Medicine, Brigham and Women's Hospital (S.G., E.I.M.), Boston, Massachusetts
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  • Author Footnotes
    ⁎ Co-First Authors.

      Abstract

      Background

      Patients with kidney disease have notable unmet palliative care needs and represent an underserved population for specialty palliative care teams.

      Intervention

      We designed a specialty-aligned interprofessional palliative care service called KidneyPal that is aimed at improving delivery of palliative care to patients with kidney disease through focus groups and iterative improvement cycles.

      Measures

      We iteratively measured the development of KidneyPal through clinical process metrics: percent of the inpatient nephrology census followed by KidneyPal, patient demographics, consult origin, clinician feedback, and self-reported team interventions.

      Outcomes

      KidneyPal saw 314 unique patients from January 2019 to January 2021. The majority of consultations came from nephrology services though the source of consultation changed over time. We consulted on an average of 13.5% of the entire inpatient nephrology patient hospital census with highest involvement with patients on the inpatient nephrology hemodialysis service (mean of 29.9%). KidneyPal was rated highly by surveyed nephrology clinicians and provided high rates of psychosocial support and goals of care interventions.

      Lessons Learned

      The creation of KidneyPal led to us to serve a new cohort of patients with specialty palliative care. We grew over time to serve the full range of patients with kidney disease as defined by our nephrology service lines. We succeeded in doing so by embedding in nephrology and building relationships with those caring for people with kidney disease while tailoring our service and interventions over time.

      Key Words

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