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Clin J Am Soc Nephrol. 2013 Oct;8(10):1783-90. doi: 10.2215/CJN.02180213. Epub 2013 Jun 6.

Five policies to promote palliative care for patients with ESRD.

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Veterans Affairs Palo Alto Health Care System Geriatrics Research Education and Clinical Center. Palo Alto, California;, †Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, ‡Center to Advance Palliative Care and Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.


Patients with ESRD experience complex and costly care that does not always meet their needs. Palliative care, which focuses on improving quality of life and relieving suffering for patients with serious illnesses, could address a large unmet need among patients with ESRD. Strengthening palliative care is a top policy priority for health reform efforts based on strong evidence that palliative care improves value. This commentary outlines palliative care policies for patients with ESRD and is directed at policymakers, dialysis providers, nephrology professional societies, accreditation organizations, and funding agencies who play a key role in the delivery and determination of quality of ESRD care. Herein we suggest policies to promote palliative care for patients with ESRD by addressing key barriers, including the lack of access to palliative care, lack of capacity to deliver palliative care, and a limited evidence base. We also provide examples of how these policies could be implemented within the existing ESRD care infrastructure.

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