1. Renal Palliative Care in WA Developments & Challenges Dr Brian Siva 21 st August 2015

2. Perth Metropolitan Area Health Service RPH FH/FSH SCGH

3. 80 year old female on hemodialysis Multiple myeloma with lytic lesions Spontaneous fractures & pain Chemotherapy Desperate to cease dialysis to ‘end it all’

13. Renal Supportive Care Clinic Fremantle Hospital 2013

14. Commenced April 2012 Staff – nephrologist, CKD nurse, palliative care nurse, social worker Fortnightly Clinic based service Referrals from nephrologists, nurses, dialysis units Information: posters, emails, RSA meeting Meeting with head of Silverchain Palliative care Presentation at the WA palliative care education night

15. Nephrologist- - Symptom management & Medication review - Prognosis and advanced health directives discussion - NFR status Palliative Care CNC - Introduce palliative care concepts - Introduce advance healthcare directives - referral to community palliative care - PCOC assessment, Symptom score CKD Nurse (CNS) - Discuss current kidney function - Quality of life (assessment) - Withdrawal from dialysis - Preparations for end of life planning

16. 2012

17. Dialysis patients deaths 2012-2014

18. Challenges: - patient recruitment into clinic - clinic vs service model - clinics were too long - advanced care planning Encouragement : - our presence was noticed - links to regional palliative care services set-up

19. FSH Renal Supportive Care clinic -Started Feb 2015 -Nephrologist, CKD nurse -Single clinic -Data collection -ACP -Mandatory for all conservative care patients

21. What the future holds: More advanced care planning Palliative care involvement Recruitment of dialysis patients (RPA 2010) – ACP, symptoms Ax Separate inpatient service for care of the dying Extension to regional/rural WA - telehealth

22. Conclusions Role of palliative care recognised Renal Palliative Care pathway 2012 FH & FSH model 2 main hurdles – funding and resources

23. Thank you “Although never easy, dying has been getting harder. Yes, it's harder to die because doctors can now diagnose and cure many more ills. But death is also harder on the patient because now we die from the debilitating, life-sucking long- term diseases”

24. Acknowledgements Sandie Porter, CKD Nurse John Robinson, Palliative care CNC Renal Service, FSH Liz, Frank and Mark (St George)