Table 1.
Results of statements of rounds 2 and 3
| Statements | Round 2 Mean (SD) | Round 3 Mean (SD) | Cohen's k | t (p) |
|---|---|---|---|---|
| Facilitators | ||||
| Impartial listening | 3.7 (0.7) | 3.5 (0.7) | 0.81 | 1.50 (0.17) |
| Active listening | 3.7 (0.5) | 3.8 (0.4) | 0.74 | 1.00 (0.34) |
| Communicating truthfully and clearly about patients' prognosis | 3.4 (0.5) | 3.5 (0.5) | 0.80 | 1.00 (0.34) |
| Involving the family of the patient in choosing dialysis or palliative care | 3.4 (0.5) | 3.4 (1.0) | 0.45 | 0.00 (1.00) |
| A collaborative approach between renal services in the hospital and the community | 3.3 (0.5) | 3.6 (0.5) | 0.44 | 1.96 (0.08) |
| Support of a renal palliative care team | 3.6 (0.5) | 3.8 (0.4) | 0.55 | 1.50 (0.17) |
| Adequate education on approaching end‐of‐life by medical staff | 3.6 (0.5) | 3.8 (0.4) | 0.55 | 1.50 (0.17) |
| Adequate education on approaching end‐of‐life by nursing staff | 3.8 (0.4) | 3.8 (0.4) | 1.00 | 0.00 (1.00) |
| Reassuring patients that they will not feel abandoned if they choose palliative care | 3.4 (0.5) | 3.9 (0.2) | 0.20 | 2.45 (0.04)* |
| Presence of a multiprofessional team | 3.6 (0.5) | 3.6 (0.5) | 1.00 | 0.00 (1.00) |
| An environment that supports innovation. research. education and dissemination of best practices | 3.7 (0.5) | 3.8 (0.4) | 0.78 | 1.00 (0.34) |
| A focus on symptom management and psychosocial support | 3.5 (0.5) | 3.7 (0.5) | 0.60 | 1.50 (0.17) |
| Patient able to die in a place of their choice | 3.5 (0.5) | 3.9 (0.2) | 0.20 | 2.45 (0.04)* |
| Good management of symptoms | 3.8 (0.4) | 3.8 (0.4) | 1.00 | 0.00 (1.00) |
| Patients talking about approaching end‐of‐life | 3.4 (0.5) | 3.6 (0.5) | 0.62 | 1.50 (0.17) |
| Presence of a specific plan of care which includes advanced care planning | 3.9 (0.2) | 3.8 (0.4) | 0.62 | 1.00 (0.34) |
| Treating the dying patient with dignity and respect | 3.7 (0.5) | 3.9 (0.2) | 0.41 | 1.50 (0.17) |
| End of life care competencies for medical staff included in university curricula | 3.5 (0.5) | 3.5 (0.5) | 1.00 | 0.00 (1.00) |
| End of life care competencies for nursing staff included in university curricula | 3.7 (0.5) | 3.7 (0.5) | 1.00 | 0.00 (1.00) |
| Participation of family/carers in decision‐making | 3.6 (0.5) | 3.3 (0.5) | 0.44 | 1.96 (0.08) |
| Presence of national guidelines that support clinical practice at the end of life period | 3.5 (0.5) | 3.7 (0.5) | 0.60 | 1.50 (0.17) |
| Providing postregistration training to nephrology nurses | 3.8 (0.4) | 3.7 (0.5) | 0.74 | 1.00 (0.34) |
| Providing a stimulating work environment with places where teams can meet, interact and reflect | 3.3 (0.5) | 3.8 (0.4) | 0.19 | 3.00 (0.01)* |
| Collaboration with a palliative care team in the community | 3.8 (0.4) | 3.8 (0.4) | 1.00 | 0.00 (1.00) |
| Medical staff communicating effectively | 3.5 (0.5) | 3.6 (0.5) | 0.80 | 1.00 (0.34) |
| Nursing staff communicating effectively | 3.4 (0.5) | 3.8 (0.4) | 0.29 | 2.45 (0.04)* |
| Medical staff have palliative care experience | 3.6 (0.5) | 3.6 (0.5) | 0.80 | 1.00 (0.35) |
| Nursing staff have palliative care experience | 3.6 (0.5) | 3.6 (0.5) | 1.00 | 0.00 (1.00) |
| Presence in the hospital of a positive attitude towards palliative care | 3.6 (0.5) | 3.8 (0.4) | 0.55 | 1.50 (0.17) |
| Implementation of standard scales for symptom assessment | 3.8 (0.4) | 3.8 (0.4) | 1.00 | 0.00 (1.00) |
| Information for the family/carers about the protection and promotion of life until death while receiving palliative care | 3.5 (0.5) | 3.8 (0.4) | 0.40 | 1.96 (0.08) |
| Availability of psychological support in complex communication | 3.7 (0.5) | 3.8 (0.4) | 0.74 | 1.00 (0.34) |
| Presence of standard hospital procedures for palliative care | 3.7 (0.5) | 3.6 (0.5) | 0.78 | 1.00 (0.34) |
| Presence of a network of nursing home staff and residential care home staff | 3.6 (0.5) | 3.7 (0.5) | 0.78 | 1.00 (0.34) |
| Identification of cultural barriers among healthcare professionals that could prevent uptake of palliative care. | 3.7 (0.5) | 3.9 (0.2) | 0.42 | 1.50 (0.17) |
| Knowledge about the different cultural approaches to the end of life | 3.7 (0.5) | 3.8 (0.4) | 0.74 | 1.00 (0.34) |
| Knowledge about spiritual needs at the end of life period | 3.7 (0.5) | 3.8 (0.4) | 0.62 | 1.00 (0.34) |
| Barriers | ||||
| Lack of training and resources to conduct difficult discussions about deterioration | 3.7 (0.5) | 3.8 (0.4) | 0.74 | 1.00 (0.34) |
| Lack of time to conduct difficult discussions about deterioration | 3.3 (0.5) | 3.3 (0.7) | 0.68 | 0.00 (1.00) |
| Involving family/carer at the end of life decision making | 3.6 (0.7) | 3.0 (0.9) | 0.63 | 3.67 (0.01)* |
| Lack of collaboration between nursing and medical staff | 3.5 (0.5) | 3.4 (0.7) | 0.86 | 1.00 (0.34) |
| Refusal by the patient to accept deterioration and approaching death | 3.3 (0.7) | 3.4 (0.7) | 0.88 | 1.00 (0.34) |
| Refusal by the family to accept deterioration and approaching death of the patient | 3.6 (0.5) | 3.6 (0.5) | 1.00 | 0.00 (1.00) |
| Fear of staff to family reactions to palliative care | 3.5 (0.5) | 3.2 (0.6) | 0.57 | 1.96 (0.08) |
| Feel unprepared to start difficult conversations. and having a fear of using the wrong words | 3.6 (0.5) | 3.4 (0.5) | 0.62 | 1.50 (0.17) |
| Cultural beliefs and practices | 3.4 (0.7) | 3.6 (0.5) | 0.72 | 1.50 (0.17) |
| Spiritual beliefs | 3.3 (0.7) | 3.6 (0.7) | 0.68 | 1.96 (0.08) |
| A lack of knowledge about which patients will benefit from renal replacement therapy rather than palliative care | 3.4 (0.5) | 3.4 (0.7) | 0.71 | 0.00 (1.00) |
| Individual survival and quality of life predictions difficult in the elderly with end‐stage kidney disease | 3.2 (0.4) | 3.4 (0.7) | 0.38 | 1.00 (0.34) |
| Absence of adequate palliative care services in rural areas | 3.4 (0.5) | 3.6 (0.7) | 0.44 | 1.00 (0.34) |
| The patient and the patient's family think that withdrawing from dialysis is the same as euthanasia | 3.5 (0.5) | 3.3 (0.5) | 0.60 | 1.50 (0.17) |
| Nephrologists focus on biomedical factors and have an inherent instinct to prolong the life | 3.5 (0.5) | 3.5 (0.5) | 1.00 | 0.00 (1.00) |
| Nephrologists try and maintain hope for the future | 3.4 (0.5) | 3.2 (0.6) | 0.69 | 1.50 (0.17) |
| Regret in patient and family about stopping dialysis | 3.5 (0.5) | 3.2 (0.4) | 0.40 | 1.96 (0.08) |
| Limited evidence to support renal palliative care in the literature | 3.5 (0.5) | 3.2 (0.6) | 0.57 | 1.96 (0.08) |
| Family/carer's involvement in the decision‐making process | 3.6 (0.7) | 3.3 (0.5) | 0.32 | 1.41 (0.19) |
| Clinicians influencing the patient to make a particular decision | 3.8 (0.4) | 3.2 (0.4) | 0.12 | 3.67 (0.01)* |
| Nurses influencing the patient to make a particular decision | 3.6 (0.5) | 3.1 (0.6) | 0.36 | 3.00 (0.01)* |
| Shared treatment decision‐making is not a common term in the renal unit | 3.5 (0.7) | 3.3 (0.7) | 0.78 | 1.50 (0.17) |
| End‐of‐life discussions are often not started by the health care team | 3.3 (0.5) | 3.4 (0.5) | 0.78 | 1.00 (0.34) |
| Difficulty in estimating prognosis | 3.6 (0.5) | 3.1 (0.7) | 0.49 | 3.00 (0.01)* |
| Death considered a taboo subject | 3.3 (0.7) | 3.4 (0.7) | 0.88 | 1.00 (0.34) |
| Nurses' lack of experience conducting palliative care | 3.7 (0.5) | 3.6 (0.5) | 0.78 | 1.00 (0.34) |
| Medical staff lack of experience conducting palliative care | 3.7 (0.5) | 3.8 (0.4) | 0.74 | 1.00 (0.34) |
| Beliefs in the preservation of hope and life | 3.6 (0.5) | 3.3 (0.7) | 0.59 | 1.96 (0.08) |
| Medical staff lack experience in end of life care | 3.5 (0.5) | 3.7 (0.5) | 0.60 | 1.50 (0.17) |
| Nurses lack experience in end of life care | 3.6 (0.5) | 3.3 (0.7) | 0.59 | 1.96 (0.08) |
| Worries about legal consequences | 3.6 (0.5) | 3.5 (0.7) | 0.86 | 1.00 (0.34) |
| Prolonging life viewed as more important than honouring a patient's request to forgo life‐sustaining treatment | 3.6 (0.7) | 3.5 (0.5) | 0.69 | 0.00 (1.00) |
| The family disagrees with the patient's wishes | 3.6 (0.5) | 3.4 (0.5) | 0.62 | 1.50 (0.17) |
| Insufficient information about palliative care in the nursing university curriculum | 3.6 (0.5) | 3.5 (0.5) | 0.80 | 1.00 (0.34) |
| Insufficient information about palliative care during medical training | 3.3 (0.5) | 3.6 (0.5) | 0.44 | 1.96 (0.08) |
| The stigma of palliative care in some cultures as an acceptance of death | 3.6 (0.5) | 3.7 (0.7) | 0.55 | 0.56 (0.59) |
*
Statistically significant p < 0.05.