Table 1.

Recommendations for Research Priorities for Palliative Care for Older Patients with Advanced Chronic Kidney Disease

Research priority	Study objective	Study setting	Sample	Study design
What matters most to older adults with CKD and caregivers at the end of life?	To describe the end-of-life experience of older adults with advanced CKD and identify opportunities for improvement	Real-world settings, dialysis centers and outpatient CKD clinics	Older adults with advanced CKD; their bereaved caregivers	Longitudinal descriptive studies, either qualitative or quantitative (survey); case–control cohort studies
	To describe the experiences of caregivers of older adults with advanced CKD in engagement in directing care?	Real-world clinical settings, dialysis centers and outpatient CKD clinics	Informal caregivers (e.g., family members, friends) of older adults with advanced CKD	Longitudinal descriptive studies, either qualitative or quantitative (survey); case–control cohort studies
	To understand the research priorities of older adults with advanced kidney disease and their caregivers	Real-world clinical settings, dialysis centers and outpatient CKD clinics	Older adults with advanced kidney disease and their caregivers	Qualitative; quantitative (surveys)
Identifying effective approaches to support older adults and their caregivers during RRT decision making	Develop and test interventions to support patients and caregivers during RRT decision making	Outpatient centers, including the dialysis centers and the primary doctor's office Inpatient care settings	Older adults with advanced CKD with multiple chronic conditions and their caregivers; Older adults with multiple chronic conditions who develop renal failure as a complication	Traditional randomized controlled trials; center-level or provider-level cluster randomized trials; pragmatic trials
Develop effective ACP interventions to improve end-of-life care for older adults and their caregivers	Examine the effects of ACP interventions in outcomes of patients and their caregivers, including care concordant with the patient's preferences and post-bereavement outcomes	Outpatient centers, including dialysis centers and the primary doctor's office	Older adults with advanced CKD with multiple chronic conditions and their caregivers	Traditional randomized controlled trials; center-level or provider-level cluster randomized trials; pragmatic trials; effectiveness implementation hybrid designs
	Examine approaches to implementing efficacious ACP interventions in clinical practice
Reconfiguring the healthcare system	Symptom management strategies	Outpatient clinic and dialysis center	Older adults with advanced CKD and high symptom burden	Traditional RCT of specific pharmacologic or nonpharmacologic interventions
				Cluster RCT at center or provider level of comparing symptom management strategies
	Effectiveness of different strategies for delivering palliative care	Outpatient and inpatient	Older adults with advanced CKD and high symptom burden and/or poor predicted prognosis	RCT of palliative care as add on to usual care or comparing different approaches to delivering palliative care
	Effectiveness of different payment models or pay-for-performance incentives on uptake of palliative care	Outpatient dialysis center	Patients receiving dialysis	Cluster RCT or matched case–control study
	Effectiveness of concurrent hospice and dialysis	Outpatient dialysis center	Patients receiving dialysis with poor predicted prognosis	Cluster RCT or matched case–control study
	Outcomes of comprehensive conservative care	Outpatient	Patients with advanced CKD and poor predicted prognosis	Observational cohort

CKD, chronic kidney disease; RRT, renal replacement therapy; ACP, advance care planning; RCT, randomized controlled trial.