Older kidney patients face a slow decline to the ends of their lives. The disease comes with altered cognition, a higher rate of dementia, frailty or other
mobility impairments, and communication challenges. Dialysis also takes a toll. At what point does quality of life outweigh the benefits of treatment?
The ideal treatment plan would note what care patients want now, and what they want as their health declines. “Our patients are dying to have those conversations,” says nephrologist Katharine Cheung, “but they need tools and guidance.
And our busy clinicians don’t know how to have those conversations.”
This is not an insignificant challenge: 10 to 15 percent of people have kidney disease. So Cheung focuses her research efforts on how to give medical providers and patients the time and language to start these discussions and continue them over time.
- Cheung is a project director at UVM’s newest Center on Biomedical Research Excellence (COBRE) Vermont Center for Cardiovascular and Brain Health (VCCBH), and is studying the trajectory of cognitive impairment in this population to understand
if and how cognition might change may alter the timing of treatment discussions.
- Cheung is also studying the feasibility of TelePalliative Care consultation with patients in rural dialysis units during treatments. Vermont subjects found that this approach saved time, was as good or better than in-person conversations,
and spurred discussions with family members. It helped align their goals with treatment plans and gave them – and clinicians – tools to talk about it.
- Cheung mentors Larner College of Medicine summer research fellows (second year medical students) who are interested in doing research on kidney disease. One feasibility study looked at the effects of mindfulness, meditation and yogic breathing.
A second, funded by a Center on Aging grant, tracked the function and resilience of dialysis patients in their first year of treatment.