Table 4.

Step-wise approach for implementation of withdrawal from dialysis

Identify decision-maker for the patient (patient or family member)

Assess patient’s decision-maker’s understanding of the patient’s clinical situation and benefit versus burden of disease

Provide explanation to the patient/family caregiver for dialysis withdrawal and rationale for it

Reassess the understanding and decision, ensuring consistency in family caregiver

Introducing palliative care services and explaining their scope in the management of the patient

Documentation of decision of withdrawal on medical records and inform primary care physician, nephrologist, and palliative care team

Implementation of withdrawal from dialysis and shifting focus of care to comfort and symptom control of patient and provision of dignified end of life care

Exploring conflict and taking steps toward conflict resolution and review the care process

Provision of bereavement care for the family members