Nondialytic options and the role of palliative care

This chapter describes the palliative care needs of patients with end-stage kidney disease (ESKD) who follow the nondialytic pathway or who withdraw from dialysis. As disease progresses and the end of life approaches, skilled communication becomes increasingly important in the delivery of effective patient care. The chapter provides some suggestions of useful 'opening questions' that nurses can use to help enable a patient or their family to raise their concerns readily. People who are being managed conservatively need much more than just symptom management. Achieving these goals requires a shift from a predominantly disease-focused approach towards more patient-centred management. Careful judgements need to be made as to when to discontinue onerous treatments; these will often depend on perceived burden and patient preference. Palliative care considers the whole person, their family, and carers. It is important to consider all aspects and dimensions of each patient's existence, since psychological, social, and spiritual issues are important.