Patient-Centered Intervention in Advance Care Planning Across Dialysis Organizations: HIGHWay: Honor Individual Goals and Hopes

Document Type

Journal Article

Publication Date

4-25-2025

Journal

Kidney360

DOI

10.34067/KID.0000000767

Abstract

BACKGROUND: Patients on dialysis want to discuss their preferences for treatment. The Shared Decision-Making-Renal Supportive Care intervention effectively elicited dialysis patient preferences for end-of-life care. The HIGHWay project updated this intervention to scale it for broader implementation of advance care planning to all patients during their regular dialysis sessions no matter ill-seriousness or time has been in dialysis and to address barriers previously found. METHODS: HIGHWay implemented advance care planning for dialysis patients of participant social workers and nurses, incorporating these conversations into the regular workflow. Participants completed a 6-hour online training course by study investigators focused on motivational interviewing and person-centered approaches. They then received 9-monthly group coaching sessions to strengthen their discussion skills. Data on participant engagement were collected via survey: pre-program, midpoint (6-months), post-implementation (9-months), and weekly surveys over the following 9-months to track conversations conducted. The Consolidated Framework for Implementation Research framework was used to measure implementation outcomes. RESULTS: We enrolled 55 social workers and nurses from 3 dialysis organizations from June 2021 to December 2023 across 61 dialysis clinics in the United States. After a 9-month follow-up period, 1,526 conversations were conducted. Of these, 868 were newly initiated cases. Participants reported an average of 1.7 conversations per week, most 30 minutes or less. The mean feasibility on 12 advance care planning-related activities on a 5-point scale increased from 3.4 (SD = 1.0) pre-training to 4.2 (SD = 0.85) after 9-months of follow-up (p <0.05). Notably, 65% of the respondents felt more skillful addressing patient reluctance and 60% reported being more at ease with advance care planning topics. CONCLUSIONS: HIGHWay enhances confidence and skills in conducting advanced care planning for patients undergoing chronic dialysis. High scores for acceptability, appropriateness, and sustainability suggest that HIGHWay is ready for widespread use across all U.S. dialysis facilities.

Department

Nursing Faculty Publications

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