Increasing hospice services for elderly patients maintained with hemodialysis.

Few dying patients undergoing dialysis receive hospice care. An intervention to facilitate hospice referral was evaluated in a longitudinal prospective cohort study. Five hemodialysis units in Massachusetts were divided into intervention sites (N = 3 clinics) and control sites (N = 2 clinics). Five hundred twelve patients were screened to identify those with indicators of poor prognoses; 133 met the eligibility criteria and consented to participate. Eighty-two intervention subjects and 51 control subjects were followed for a median of 17 months. During that time, 45 died and 16 received hospice services. Directors from the community hospices were approached by the researchers and agreed to provide an educational outreach to the intervention clinics. Renal supportive care teams (RSCTs) consisting mainly of volunteer health-care providers recruited from the dialysis clinics and local hospices were notified about the high-mortality patients. Staff met periodically to discuss their contacts with subjects and/or family members from the intervention clinics, The subjects were encouraged to participate in advance care planning, and they were provided information about hospice resources. The control clinics did not have RSCTs, and their subjects received standard treatment. At the conclusion of the study, hospice services had increased at the intervention sites (p = 0.09), and the subgroup of > or = 65-year-old subjects had undergone a significant increase (p = 0.05) in obtaining hospice care. Greater familiarity between hospice and dialysis staff along with outreach to patients with poor prognoses holds the promise of expanding hospice use--especially for the elderly.