Renal Supportive Care
Renal Supportive Care (RSC) involves an interdisciplinary approach that integrates the skills of renal medicine and palliative care to help patients with chronic kidney disease (CKD) and end stage kidney disease (ESKD) to live as well as possible by better managing their symptoms and supporting them in living with advanced disease. It is a program that is embedded in usual renal care. It also encompasses advance care planning and end-of-life care.
Key principles of RSC model
The key principles of RSC are that:
- Patients and their families are engaged early, including at the time of deciding on the best treatment pathway.
- Patients choosing not to receive renal replacement therapy continue to receive care from renal staff, including their nephrologist.
- For patients receiving renal replacement therapy, RSC is provided in addition to usual renal care, and does not replace this care.
- Patients receive care close to where they live. This means that RSC is available within each health service so that it is accessible locally. In some areas it may also mean that, for patients who live a distance away and cannot travel to the service, staff travel to the patient’s home to deliver care.
- RSC is patient-centred, focussing on reducing pain and suffering and maximising quality of life.
Key features of RSC model
Key features of the NSW RSC model:
- It is a nurse-led model. The nurse is supported by a palliative care physician (or other medical/ nursing practitioner that can assist with the medical aspects of managing the high symptom burden of the target population), and a dietitian and social worker where available.
- It is explicitly embedded within existing renal services, and not as an adjunct to these services. The rationale for this is that RSC is most needed at times of high patient and carer stress, when transition to a new team is least likely to be successful. This also incorporates the principle of non-abandonment. That is, patients with CKD and ESKD will continue to receive care from their nephrologist and the renal unit, regardless of their decision to not embark on or cease renal replacement therapy.
- A nephrologist provides local leadership for the RSC service.
- It is a networked model.
- These features are in addition to those of an RSC service generally, which include linkages and a close working relationship between the renal service and the palliative care service.
Current NSW model
In NSW there are three hubs that provide networked support:
- St George Hospital supports
- SLHD: Concord, Royal Prince Alfred Hospitals
- SESLHD: St George, Sutherland and Prince of Wales Hospitals
- ISLHD: Wollongong Hospital
- NSLHD: Royal North Shore Hospital
- WNSWLHD: Dubbo Base, Orange Base Hospitals
- FWLHD: Broken Hill Hospital
- SVHN: St Vincent’s Hospital
- Nepean Hospital suports
- WSLHD: Auburn, Blacktown and Westmead Hospitals (part of the Western Renal Network)
- NBMLHD: Nepean Hospital (part of the Western Renal Network)
- SWSLHD: Bankstown, Bowral, Campbelltown, Fairfield and Liverpool Hospitals
- MLHD: Griffith and Wagga Wagga Base Hospitals
- SNSWLHD: Bega, Cooma, Goulburn, Moruya and Queanbeyan Hospitals
- John Hunter Hospital supports
- CCLHD: Gosford Hospital
- NNSWLHD: Lismore and The Tweed Hospitals
- MNCLHD: Port Macquarie, Kempsey and Coffs Harbour Hospitals
- HNELHD: John Hunter, Tamworth and Taree Hospitals
ACI support model
- In 2015/16 NSW Health provided recurrent funding for the statewide roll out the Renal Supportive Care Model in a networked approach
- The ACI Renal Network Working Group is supporting the roll out of this model across the state
- Local teams can be supported through discussion on support that may be required to increase the number of services that can be provided through existing services