Table 2.

Proposed recommendations and barriers addressed

Recommendation	Barriers Addressed
Nephrologists and nephrology fellows should develop expertise in discussing prognosis and goals of care	Nephrologists often lack skills to address prognosis and goals of care for patients with ESRD
	Infrequent end-of-life discussions among dialysis patients
Develop metrics for a palliative approach to dialysis care	Current standard-of-care metrics disease-focused rather than patient-centered
Determine the fiscal impact of a palliative approach to dialysis care	Inflexible in-center hemodialysis schedules
	Lack of reimbursement for staff-assisted home dialysis
	Hospice benefit covers dialysis only if terminal illness other than ESRD