Integrated renal-palliative care in Germany - Results from a survey on end of life care in a non-profit provider

Background Palliative care-related problems in end-stage renal patients are similar to those of cancer patients. While the literature on renal palliative care is growing, real-world data on practice patterns of an integrated palliative care approach (IPCA) in Germany are lacking. Method An anonymous survey of end of life care (ELC; conservative treatment, dialysis withdrawal, decision making) was mailed to head physicians of adult renal centers (N = 198) including 13 structured questions and 1 open question for more detailed information on the current state of ELC. A free text analysis of the quality of established care and further requirements was provided. Results Responses were received from 122 centers (62%) with 14,197 dialysis and 159,652 renal outpatients. Of the 122 centers 86 provided detailed responses to the open question and 4 different thematic patterns could be identified: centers with successfully established ELC (N = 17, 20%, group 1), those where intensified training and education were required (N = 19, 22%, group 2), centers which required structural improvement to establish IPCA (N = 39, 45%, group 3) and those which did not require further supportive measures (N = 11, 13%, group 4). Physician's age, sex, years of working in renal medicine, center size, and proportion of dialysis withdrawal and conservative treatment were not significantly different between the groups. Conclusion Despite equal general conditions, only 20% reported successfully established IPCA. Two out of three centers requested specific measures to establish or improve palliative care. Implementation of IPCA is hampered by educational and structural constraints. These real-world data suggest that structural determinants and soft skills (e.g. team motivation, leadership) can influence ICPA.