GO WISH CARDS: AN ALTERNATIVE METHOD OF DISCUSSING END OF LIFE IN HAEMODIALYSIS PATIENTS

Patients on kidney replacement therapy (KRT) face higher rates of hospitalisation, intensive care admissions and mortality (Kerr et al., 2017, Rodriguez de Soda et al., 2022). Despite this, only around 30% of patients on KRT had discussed advance care planning (ACP) and end-of-life (EOL) care preferences with healthcare professionals or relatives before their deterioration (Lunardi et al., 2020). Barriers may include patients’ sense of disengagement from clinical decision-making and reluctance to discuss prognosis and EOL (Tong et al., 2014, Goff et al., 2015).

The Go Wish Cards (GWC), specialised playing cards with statements regarding EOL care, have been used to aid such discussions in oncology (Paiva et al., 2024). We aimed to utilise the GWC to describe EOL care preferences for patients on haemodialysis and their views of the acceptability of the GWC for these discussions.

This was a cross-sectional study in a local health district in Sydney. We recruited adult, cognitively intact, English-literate patients on either in-centre or satellite haemodialysis. Participants completed a survey prior to the GWC interaction, which included demographics, the “Advance Care Planning Engagement Survey” (Sudore et al., 2017), and quality of life outcomes measure (EQ-5D-5L). Participants then chose ten cards as “Very important”, ranked in order of importance, and ten cards as “Not important,” ranked in order of least importance. Afterwards, participants again completed the “ACP Engagement Survey” and rated whether they found the GWC helpful for planning ACP and whether they would recommend the GWC.

McNemar’s test was used to determine whether the GWC improved readiness to engage in ACP. Binomial logistic regression was used to determine the variables significantly associated with whether patients found the GWC helpful or if they would recommend the GWC. 

37 patients were included from both in-centre and satellite dialysis centres. Table 1 shows the baseline demographics. Table 2 shows participants’ readiness to participate in ACP before and after the GWC interaction, as measured by the ACP Engagement Survey items. After the GWC interaction, there was a trend toward significance that a greater proportion of patients were willing to sign official papers regarding EOL care wishes (p = 0.06). The statement that most patients ranked as the most important was “I do not want to be a burden to my family” (5, 14%). The statements ranked as being the most important most often fell into the “Relationships” category (19, 51%).  The statement that most patients ranked as least important was “I want someone to chant or pray after I die.” The statements ranked as being the least important most often fell into the “Existential/Spiritual” category (13, 35%). 27 (73%) of patients agreed or strongly agreed that the GWC helped them plan their ACP. 30 (81%) of patients agreed or strongly agreed that they would recommend this approach to others. There were no significant variables associated with either outcome.

Patients on haemodialysis found GWC an acceptable, helpful aid for facilitating ACP discussion. The GWC may even increase patients’ readiness to sign an official ACP. Although we are limited by small numbers and cultural diversity, GWC appears to be promising for patients that may be reluctant to discuss EOL.