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Evaluating and improving care

Renal failure

The department is leading several initiatives to improve care of patients with advanced kidney disease in the last year of life, and has been recognised internationally as one of leading centres working on improving palliative and end of life care for those with advanced kidney disease.

Advanced Renal Care - the ARC project: A test site for NHS Kidney Care

This project, led by Dr Fliss Murtagh and funded by NHS Kidney Care as a national test site for improving renal palliative care, is a King’s Health Partners project, across King’s College London, King’s College NHS Foundation Trust, and Guy’s & St Thomas’ NHS Foundation Trust. To improve the quality of care for patients with advanced kidney disease approaching last year of life, the work completed in 2010-11:

  • Identified dialysis patients approaching the last year of life Implemented a Gold Standards care programme for these patients
  • Systematically introduced advance care planning, exploration of preferred place of care, and detailed end of life care planning within this programme, in accordance with patient preferences
  • Trained and supported nephrology professionals in advanced communication, palliative and supportive care skills in order to support these interventions
See: BRISTOWE K, SHEPHERD K, Bryan L, Brown H, Carey I, Matthews B, O’Donoghue D, Vinen K, MURTAGH F. The development and piloting of the REnal specific Advanced Communication Training (REACT) programme to improve Advance Care Planning for renal patients. Palliative Medicine. Advance online publication. doi:10.1177/0269216313510342.


Dialysis withdrawal: understanding illness trajectories in last year of life

Undertaken as a PhD project by Emma Murphy, and supervised by Dr Fliss Murtagh, Dr Teresa Wiseman, and Professor Irene J Higginson, this study focuses on defining dialysis withdrawal, understanding the predictors of withdrawal from dialysis, and exploring the experience of these patients during the last year of life, in order to improve patient-related outcomes. Emma has been awarded an NIHR Allied Healthcare Professional/Nurse Research Training Fellowship by the Biomedical Research Centre at Guy’s & St Thomas’ NHS Foundation Trust and King’s College London.


Understanding & improving the quality of end of life care for patients dying with end-stage renal disease

This three year study, led by Dr Fliss Murtagh between 2004-8, focused on understanding palliative care needs in end-stage renal disease. It described symptoms, experiences and other patient-based factors (in particular: age; comorbidity; and functional status) that influence the quality of end of life care and outcomes for end-stage renal disease patients managed conservatively, i.e. without renal replacement therapy. It adopted mixed methods, with two simultaneous components: a longitudinal survey of symptoms and quality of life, plus qualitative interviews with patients and carers to explore the impact of symptoms, information needs and care preferences. Funded by Guy's and St Thomas' Charity, the study was completed in 2009, but additional presentations, publications and other outputs continue to be produced.

The renal palliative care work also links with other departmental and collaborative projects, including work on living and dying in society in advanced renal disease and understanding costs and complexity across conditions and settings, including in advanced disease. 

For further information on this workstream, please contact

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