Successful Implementation of Advance Care Planning in National Dialysis Organizations: The HIGHWay Project (RP111)

Outcomes 1. Learners will understand that advance care planning (ACP), helps relieve patient concerns about the future, lays the foundation for better goal concordant care at the end of life, and fosters a deeper connection between the patient and the dialysis care team.2. Learners will know HIGHWay training strategy, which focused on a patient-centered approach to elicit patient's goals, hopes and concerns and bolster social worker skills through case discussion and mentoring. Key Message Advance Care Planning (ACP) gives patients agency over their future healthcare, but few patients with kidney disease complete ACP, nor are dialysis clinic staff adept at ACP do so. The HIGHway ACP training for dialysis clinics empowered them to incorporate ACP into large dialysis organization workflows. Importance Meaningful ACP conversations can change end of life (EOL) outcomes to increase hospice referral, reduce unwanted hospitalization, and improve caregiver and patient satisfaction. The HIGHWay project, the way to “Honor Individuals Goals and Hopes” adapted ACP training, documentation tracking, implementation processes and workflow standardization of three national dialysis organizations. Objective(s) Implement the HIGHway intervention with dialysis clinic social worker or nurse, training them to conduct ACP using best practice communication skills. Develop a long-term implementation and scale-up plan with a national diverse stakeholder group. Scientific Methods Utilized The prior Shared Decision Making – Renal Supportive Care (SDM-RSC) study tested an intervention to improve ACP for dialysis patients. We updated SDM-RSC, My Way and Pathway studies with an on-line 6-hour training followed by 9 months of “booster” sessions focused on case discussions and skill building. A Diverse National Advisory Council was included to facilitate uptake, and implementation scale up, and we worked with dialysis organizations on ACP documentation processes and offered ACP to all patients with ESRD. A before-after design measured trainee perception of the “doability” of 12 ACP components. Weekly surveys tracked number of ACP conversations held and documented. Results 49 SW/nurses rated how "doable" (1-less to 5-very) it is for you to carry out ACP components. The mean score increased from 3.4 pre-training to 4.2 after 9 months (p < 0.05). Before training, only 3 were rated doable, improving to 9 out of 12 doable at program close. After 9 months, 1,526 ACP conversations were held. 868 were newly initiated conversations. Conclusion(s) Implementation of HIGHway facilitated ACP processes and let to increased the number and quality of ACP conversations. Impact HIGHway normalized ACP in the dialysis setting and embedded it in the workflow of dialysis providers. Meaningful ACP, an essential component of goal-concordant care, was shown to be feasible within the time constrained dialysis clinic setting. Keywords Advanced care planning, shared decision making/Educational, training and supervision