A recent article in CJASN promotes 5 policies that are essential to provide good palliative care in ESRD.
1. Universal screening for palliative care(PC) needs: How can this be done? Questionnaires and screening tools. One such example is the surprise question tool.
2. Incorporate PC measures in ESRD QIP: The advance care planning and documentation of code status can be a start. What has been done thus far has not touched PC.
3. Train the nephrology workforce to deliver PC: This is the most essential piece. With the current fellowship structure, is this possible? Are the faculty in major academic centers even comfortable? Lot of work to be done in this area. A recent study showed that PC experience of renal fellows is very poor.
4. Payment reform for PC services: Incentive always works
5. Fund PC research: Hope this will also happen as well.
The last two policies will only work when big health systems and medical schools promote the science of palliative care. It's about time sub specialists train in PC irrespective of their specialty- cardiology, GI, heme/onc, critical care or renal.
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