LAUSR

BACKGROUND Comprehensive Conservative Care (CCC) is an emerging treatment option in kidney failure (KF), but its implementation has been restricted by a limited understanding of KF populations, outcomes, and clinician experiences. AIM This pilot study aims to investigate the characteristics of patients who are opting for (CCC) in North Queensland, Australia. It also aims to highlight clinician factors impacting treatment discussions. METHODS It is an observational study facilitated through an online cross-sectional survey to nephrologists, nephrology advanced trainees, and nurse practitioners working across North Queensland. RESULTS Study participants disagreed with the statement that patients commencing dialysis are more likely to have cardiac co-morbidities (46.7%), diabetes (40.0%), stroke (60.0%), liver disease (60.0%), chronic lung disease (53.3%), cognitive impairment (60.0%), and use of mobility aids (80.0%) than those commencing CCC. Conversely, they agreed that patients commencing dialysis are more likely to be independent (66.7%) and living in their private residence (40.0%). The median frailty score in patients choosing dialysis was 3.0 (IQR 2.8 - 3.3), whilst that of patients selecting CCC was 4.5 (IQR 3.8 - 7.0). Our participants were aware of at least one clinical prognostication tool, and the one most frequently used was the 'Surprise Question' (46.2%, n=6). Overall, our participants demonstrated low confidence (median 8.0%, IQR 6.0-8.0% ) in facilitating CCC discussions. CONCLUSION Patients who are highly co-morbid, frail, and have functional impairment are suitable candidates for CCC. More effort needs to be placed on objective prognostication of patients and the upskilling of clinicians to advocate for, and deliver, CCC. This article is protected by copyright. All rights reserved.