Figure 1.

Bow-tie model of palliative care integration in kidney disease. The bow-tie model highlights support of the patient and their family, concurrent with treatment of the disease, and the role of early integration of primary and/or subspecialty palliative care, while not diminishing the hope for survival. Dependent on patient and family goals, a range of complementary disease-targeted and palliative-focused care is available, with maximum (max) disease-targeted therapy represented by the top of the figure, and maximum conservative therapy represented by the bottom of the figure. Progression of the disease from diagnosis to realization of ultimate care goal is delineated from left to right. As the patient and their family move through their disease experience, their goals evolve, and kidney disease progresses, primary and subspecialty palliative care may take a larger role, ultimately with a transition toward kidney transplant and survivorship, or hospice and bereavement. Adapted from ref. (15), with permission.