Documentation Template for Dialysis Discussion
I discussed with the patient/family the possibility of dialysis treatment for kidney failure, including what the treatment entails, the available options, and the expected outcomes.
Key Discussion Points Documented:
Treatment Options Explained
- Available dialysis modalities: In-center hemodialysis (3x/week treatments), home hemodialysis, peritoneal dialysis (continuous or automated), and kidney transplantation 1
- Conservative management option: Continuing medical management without dialysis, including comprehensive end-of-life care and palliative support 1
- Time-limited trial: Option to try dialysis for a defined period to assess benefit before making long-term commitment 1
- Stopping dialysis: The right to discontinue dialysis at any time and receive palliative care 1
What Dialysis Entails
- Hemodialysis specifics: Requires vascular access (fistula, graft, or catheter), typically 3-4 hour sessions three times weekly, with potential side effects including cramping, hypotension, and access-related complications 2
- Peritoneal dialysis specifics: Requires catheter placement in abdomen, daily exchanges at home, with option for nurse or family assistance if needed 1
- Treatment burden: Significant time commitment for patient and family, ongoing medical appointments, dietary restrictions, and medication management 2, 3
Prognosis Discussion
- Life expectancy estimates: Discussed survival expectations with and without dialysis, acknowledging the difficulty and imprecision of individual predictions 1
- Quality of life impact: Reviewed how dialysis may affect daily activities, independence, symptom burden, and overall well-being 1
- Comorbidity considerations: Discussed how existing medical conditions (diabetes, heart disease, frailty) affect dialysis outcomes 4, 3
Timing Considerations
- Current kidney function: Reviewed that dialysis is typically initiated based on symptoms rather than a specific GFR number, and that early initiation (eGFR >10 mL/min/1.73m²) does not improve survival 1, 3
- Symptom assessment: Discussed uremic symptoms that would indicate need for dialysis (fluid overload, severe nausea, confusion, uncontrolled electrolytes) 1, 5, 3
Patient Understanding Confirmed
- Patient/family demonstrated understanding of treatment options and their consequences 1
- Patient's values, preferences, and treatment goals were elicited and documented 1
- Questions were answered and patient/family given time to consider options 1
Advance Care Planning
- Discussed importance of advance directives and documenting treatment preferences 1
- Identified healthcare decision-maker if patient loses capacity 1
Follow-up Plan
- Scheduled for ongoing discussions as kidney disease progresses 1
- Plan to reassess treatment goals if major complications occur 1
- Referral to nephrology for specialized management and dialysis access planning (if appropriate) 6
Patient/family expressed [insert patient's preference or need for more time to decide]. Will continue shared decision-making process.
Copy the above template and customize the bracketed sections based on your specific patient discussion.