Patient-Centered Advance Care Planning in Dialysis

Key Points Honoring Individuals Goals and Hopes Way: Implementing Advance Care Planning for Persons with Kidney Disease on Dialysis (HIGHWay) empowers dialysis social workers and nurses to lead advance care planning (ACP) discussions with patients as part of their workflow. HIGHWay uses motivational interviewing to overcome barriers in ACP, improve conversation quality, and help engage patients. HIGHWay demonstrated successful adoption, feasibility, and acceptability for ACP practices and outcomes despite barriers in patient readiness and time. Background Patients on dialysis want to discuss their preferences for treatment. The Shared Decision-Making Renal Supportive Care intervention effectively elicited dialysis patient preferences for end-of-life care. The Honoring Individuals Goals and Hopes Way: Implementing Advance Care Planning for Persons with Kidney Disease on Dialysis (HIGHWay) project updated this intervention to scale it for broader implementation of advance care planning (ACP) to all patients during their regular dialysis sessions, no matter the severity of illness or time on dialysis, and to address previously found barriers. Methods HIGHWay implemented ACP for dialysis patients of participating social workers and nurses, incorporating these conversations into the regular workflow. Participants completed a 6-hour online training course made by study investigators, focusing on motivational interviewing and person-centered approaches. They then received nine monthly group coaching sessions to strengthen their discussion skills. Data on participant engagement were collected by survey; preprogram, midpoint (6 months), postimplementation (9 months), and weekly surveys were conducted over the following 9 months to track conversations. The Consolidated Framework for Implementation Research framework was used to measure implementation outcomes. Results We enrolled 55 social workers and nurses from three dialysis organizations from June 2021 to December 2023 across 61 dialysis clinics in the United States. After a 9-month follow-up period, 1526 conversations were conducted. Of these, 868 were newly initiated cases. Participants reported an average of 1.7 conversations per week, most 30 minutes or less. The mean feasibility on 12 ACP-related activities on a 5-point scale increased from 3.4 (SD=1.0) pretraining to 4.2 (SD=0.85) after 9 months of follow-up ( P < 0.05). Notably, 65% of the respondents felt more skillful addressing patient reluctance and 60% reported being more at ease with ACP topics. Conclusions HIGHWay enhances confidence and skills in conducting ACP for patients undergoing chronic dialysis. High scores for acceptability, appropriateness, and sustainability suggest that HIGHWay is ready for widespread use across all US dialysis facilities. Clinical Trial registry name and registration number: NCT05324878. Podcast This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/K360/2025_06_26_KID0000000767.mp3