The Effects of Advance Care Planning in Patients with Chronic Kidney Disease on Access to Palliative Care

Abstract

     This study aimed to analyze the situation and problems in caring for end-stage chronic kidney disease (CKD) patients, to develop an Advance Care Planning (ACP) model for enabling access to palliative care, and to examine the outcomes of ACP on such access. A Participatory Action Research (PAR) approach was employed in combination with a Research and Development (R&D) process. The participants included 10 patients with end-stage CKD and their primary caregivers who received services at a Subdistrict Health Promoting Hospital between January and April 2025. Research instruments included a general information questionnaire, a quality of life assessment, an ACP form, and in-depth interview guidelines. Quantitative data were analyzed using descriptive statistics and paired t-tests, while qualitative data were analyzed using content analysis.

     The results revealed that after implementing the ACP program, patients demonstrated clearer treatment decisions. The proportion of those choosing palliative care increased to 56.7%, while those opting for renal replacement therapy decreased to 43.3%. Clinical outcomes such as blood pressure and potassium levels significantly decreased (p<.01), hematocrit levels significantly increased, and the use of erythropoietin rose from 2.9% to 38.2%. Overall quality of life improved from a low to a moderate level (p<.01), and the burden of kidney-related symptoms and their impact on daily life significantly declined.