Impact of kidney supportive care interventions on palliative care outcomes of people with advanced chronic kidney disease: a scoping review.

Abstract
Background
People with advanced chronic kidney disease may have complex Nursing care needs that often require palliative care support, referred to as ‘kidney supportive care (KSC)’. KSC integrates kidney care and palliative care to improve patient outcomes. Yet it remains unclear whether integrative KSC generates desired patient outcomes, particularly palliative care outcomes. Therefore, this review aimed to understand the impact of KSC interventions on palliative care outcomes of people with advanced chronic kidney disease.

Methods
A scoping review was conducted across three electronic databases: CINAHL, PubMed, and PsychINFO. The search was restricted to peer-reviewed research papers in human subjects (adults over 18 years) published in English between January 2010 and December 2024. Additional relevant literature was identified from the reference lists of eligible sources.

Findings
Thirty-eight studies met the inclusion criteria and were included in the data extraction. Of these, more than half
involved interventions related to advance care planning (n=24), followed by shared-decision making (n=12).
Eight studies each described symptom management, end-of-life care, and bereavement outcomes. The improved care outcome most often described was advance directive completion/ advance care planning (n=14) followed by decisional satisfaction/conflict/ patient-surrogate congruence in decision-making (n=11). Most studies reported an overall positive impact of KSC interventions on advance directive completion/advance care planning, decisional satisfaction, health services utilisation, and symptom control.
Discussion, Conclusion
Though the existing evidence reports a positive impact on patient care, meaningful conclusions on a person’s
quality of life and psycho-spiritual well-being are limited due to insufficient evidence. Also, the reported outcomes vary across treatment modalities (e.g., dialysis, conservative kidney management), participant demographic characteristics, and the content of the KSC intervention. Therefore, an in-depth analysis of the evidence is needed to better understand how Nurses can deliver KSC and to explore the underlying complex mechanisms that contribute to patients’ holistic wellbeing.

References
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