Clinical Outcomes and Quality of Life of Patients with End-Stage Chronic Kidney Disease following Advance Care Planning in the Community
DOI:
https://doi.org/10.14456/dcj.2026.24Keywords:
advance care planning, LDL-C goal achievement, palliative care, quality of lifeAbstract
This participatory action research aimed to: 1) examine the situation and problems in caring for patients with end-stage chronic kidney disease in the community; 2) develop an advance care planning (ACP) process appropriate to the local context; and 3) evaluate the effects of the model on clinical outcomes, quality of life, and treatment decision-making. The sample consisted of 20 patients. Data were collected between January and April 2025. Research instruments included a demographic questionnaire, a quality-of-life assessment, and a clinical outcomes record form. Quantitative data were analyzed using descriptive statistics and compared before and after the intervention using paired t-test, while qualitative data were analyzed using content analysis. The results revealed that the existing care system had limitations in service structure, resource allocation, and multidisciplinary communication. After implementing the ACP process, patients demonstrated clearer treatment decision-making. The proportion of patients choosing palliative care increased from 30.0% to 56.7%, while those choosing renal replacement therapy decreased from 70.0% to 43.3%. Clinical outcomes showed significant reductions in systolic and diastolic blood pressure (p=0.010 and 0.019 respectively) and serum potassium levels, along with a significant increase in hematocrit levels (p=0.005 and 0.001respectively). Additionally, the proportion of patients receiving erythropoietin increased from 2.9% to 38.2%. Quality of life significantly improved, with overall scores increasing (p=0.003). Scores related to disease burden, symptoms, and the impact on daily life significantly decreased (p<0.001, 0.028 and <0.001 respectively). In conclusion, the participatory ACP process effectively enhanced informed treatment decision-making and led to significant improvements in clinical outcomes and quality of life among patients with end-stage chronic kidney disease in the community.
Downloads
References
The Nephrology Society of Thailand. Clinical practice guidelines for chronic kidney disease. Bangkok: The Nephrology Society of Thailand; 2022. (in Thai)
Department of Medical Services (TH). Guidelines for end-of-life care. Bangkok: Ministry of Public Health; 2019. (in Thai)
Department of Disease Control (TH). Bureau of Risk Communication and Health Behavior Development, 2025 [Internet]. [cited 2025 Jul 31]. Available from: https://ddc.moph.go.th/brc/news.php?news=50932&deptcode=brc&news_views=274
Khon Kaen University. Chronic Kidney Disease Prevention in the Northeast of Thailand (CKDNET) [Internet]. 2016 [cited 2025 Jul 31]. Available from: https://ckd.kku.ac.th/?page_id=2
Udontak A, Wannakoth S, Lamaisri W, Chaisuk Mollerup T. Development of a care system for end-stage renal disease patients without palliative renal replacement therapy with the participation of a multidisciplinary team and a network in Khao Wong District, Kalasin Province. Journal of environmental and community health [Internet]. 2023 [cited 2025 Jul 31];8(2):532-44. Available from: https://he03.tci-thaijo.org/index.php/ech/article/view/1564/1049 (in Thai)
World Health Organization. Palliative care: Key facts. Geneva:WHO; 2020.
Bernacki R, Block SD. Communication about serious illness care goals: A review and synthesis of best practices. JAMA Internal Medicine. 2014:174(12):1994–2003. doi: 10.1001/jamainternmed.2014.5271
Department of Mental Health, Ministry of Public Health. The World Health Organization Quality of Life Brief Version, Thai edition (WHOQOL-BREF-THAI) [Internet]. 2015 [cited 2025 Jun 11]. Available from: https://dmh.go.th/test/whoqol/
Sudore RL, Lum HD, You JJ, Hanson LC, Meier DE, Pantilat SZ, et al. Defining advance care planning for adults: a consensus definition from a multidisciplinary delphi panel. J Pain Symptom Manage. 2017;53(5):821-32. doi: 10.1016/j.jpainsymman.2016.12.331
Department of Medical Services (TH). Guidelines for end-stage patient care. Nonthaburi: Department of Medical Services; 2019. (in Thai)
Siriyapan S, Chaigate N, Suntarutti N. Development of renal palliative care for end-stage renal disease with denial renal replacement therapy in Yala Hospital. Thai Journal of Public Health and Health Sciences [Internet]. 2021 [cited 2025 Jul 31];4(2):1-15. Available from: https://he02.tci-thaijo.org/index.php/tjph/article/view/245298 (in Thai)
Promarat C. The result of home palliative care model development, Ban Hong health network, Ban Hong district, Lamphun province. Lanna public health journal [Internet]. 2017 [cited 2025 Jul 31];13(1):25-36. Available from: https://he02.tci-thaijo.org/index.php/LPHJ/article/view/165596/119860 (in Thai)
Kidney Society of Thailand. Clinical practice guidelines for chronic kidney disease. Bangkok: Kidney Society of Thailand; 2022. (in Thai)
Tangpulpolwanit N, Suleesathira N, Chuenta S. The development of palliative care system for end of life patients at Yasothon Hospital. Journal of environmental and community health [Internet]. 2020 [cited 2025 Jul 31];5(2):36-45. Available from: https://so06.tci-thaijo.org/index.php/hej/article/view/252715/170589 (in Thai)
Noble HR, Agus A, Brazil K, Burns A, Goodfellow NA, Guiney M, et al. Palliative care in chronic Kidney disease: the PACKS study-quality of life, decision making, costs and impact on carers in people managed without dialysis. BMC nephrology. 2015;16(1):104. doi: 10.1186/s12882-015-0084-7.
Tonkhet C, Navapongsakorn O, Bonkhunthod P, Chaiwong N. Development of a palliative care model for patients with end-stage chronic kidney disease affecting clinical outcomes and quality of life. Journal of Environmental Education Medical and Health [Internet]. 2025 [cited 2025 Jul 31];10(1):20-27. Available from: https://so06.tci-thaijo.org/index.php/hej/article/view/280549 (in Thai)
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Disease Control Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles published in the Disease Control Journal are considered as academic work, research or analysis of the personal opinion of the authors, not the opinion of the Thailand Department of Disease Control or editorial team. The authors must be responsible for their articles.
