Project Description
Telemedicine Facilitated Palliative Care Consultations in Rural Dialysis Patients
There
are over 703,000 patients receiving dialysis in the U.S. and 20% die annually.
Dialysis patients experience a high symptom burden as well as depression,
anxiety, existential tension and spiritual needs that are not addressed by
current dialysis care models. Perhaps for these reasons, 60% of dialysis
patients regret starting dialysis and 20% withdrawal from treatment. Compared
to patients with cancer or heart failure, dialysis patients have more frequent
hospitalizations and invasive procedures at the end of life and less use of
hospice services. Palliative care has not yet been integrated into dialysis
care but could enhance goal concordant care, enhance prognostic understanding
and improve outcomes. It may also reduce cost by avoiding non-beneficial and
unwanted treatments. There are barriers to implementing palliative care into
dialysis care: 1) the scarcity of palliative care providers and 2) time-intensive
and often tiring dialysis treatments that limit desire to travel outside of the
unit for additional appointments. We propose an innovative solution to address
these barriers: telemedicine facilitated palliative care consultations in rural
dialysis units. At the University of Vermont, we have a rapidly expanding
telemedicine network with a rigorous consultative program in several
disciplines. We propose the following aims: 1) Assess the feasibility and
acceptability of delivering palliative care consultations to rural dialysis
patients, 2) Explore the content and process of telemedicine palliative care
consultations that are associated with patient rated quality of communication,
and 3) Benchmark the trajectory of 6- month health service utilization
(hospitalization, withdrawal from dialysis, hospice rates) in patients
receiving telemedicine facilitated palliative care consultations. The proposed
career development award will combine focused training in communication
measurement, prospective interventional studies and telemedicine science, and
will support Dr. Cheung in becoming a leader in renal palliative care with
expertise in serious-illness communication among older adults with kidney
disease.
Bio
Katharine L. Cheung, MD, PhD is an Assistant Professor of
Medicine at the University of Vermont Larner College of Medicine and is a
practicing nephrologist. Her research focuses on improving the care for older
adults with advanced kidney disease including access to palliative care,
improving functional status and resilience. She received her B.A. in Women’s
Studies at Tufts University, M.Sc.
in Physiology and Biophysics and M.D. from Georgetown University and Ph.D. in
Clinical and Translational Science at the University of Vermont. Dr. Cheung
completed her residency and chief residency in Internal Medicine, and
Nephrology Fellowship at Stanford University. During this Career Development
Award she will determine the feasibility of telemedicine facilitated palliative
care consults in rural dialysis patient, characterize the content and processes
related to quality of communication and benchmark the health service
utilization related to these consults.
Email: Katharine.L.Cheung@med.uvm.edu