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Interprofessional Practice Based Research

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Name: Courtney Sas

Role: Social worker

Research interests: Dialysis, renal disease, goals of care

Project title: Deciding to stop: considerations for fully informed decision-making in end-stage renal disease

Fun trivia: Hidden talent - Irish dancing


October 10, 2018

Tough conversations, difficult end-of-life-decisions

In this age of medical advancement and technological strides, people are living longer than they have previously. Even for conditions where cures are not yet possible, there may be life-sustaining treatment options. Take for example patients with end-stage kidney disease who can go on dialysis. Dialysis machines do the job of our kidneys by filtering the blood and removing toxic waste from the body. This can prolong life potentially for many years. For patients who are unable to get a kidney transplant, dialysis is the only viable option. However, it comes at a cost. Dialysis requires patients to visit clinics up to five times a week for four to five hours per visit. This can be extremely burdensome and onerous. For some patients, specifically those with multiple health concerns, dialysis may not actually extend their life expectancy.

For patients with end-stage renal disease, it comes down to a choice. To pursue dialysis or to consider palliative options that focus on maximizing their quality of life until death. As you can imagine, end of life conversations about the patient’s goals, and values, and preferences around their treatment are really difficult to have. But these conversations are crucial if patients are going to be given a choice. “Patients should feel empowered and in control of their disease as much as possible. It is important that we listen to patients, hear what they have to say, and not project our own values on to them,“ said Courtney Sas, a social worker at St. Michael’s Hospital, Nephrology unit.

Courtney has developed educational resources to facilitate these goals of care conversations. She works with the clinical team to ensure that each patient has an opportunity to make choices around their treatment; to know their options, understand the potential risks and rewards, and weigh the pros and cons against their values and preferences. She aims to ensure that patients can set their own goals of care and share these goals with their medical team and their caregivers/ families.

According to Courtney, there is still a lot to know in terms of how to implement these educational initiatives. She indicates that “anecdotally we think that what we are doing is important and serves a need but we are very curious to know if research supports our theory.” To address these questions, Courtney is collaborating with Alison Thomas, a nurse practitioner on the hemodialysis unit, to understand whether these educational resources and goals of care conversations are effective from the perspective of the patient and clinician. They also aim to determine whether these educational resources result in improved communication and long term care for these patients according to their care goals.

Connecting with IPBR

The Interprofessional Practice Based Research program at St. Michael’s Hospital assists nurses and health disciplines professionals at St. Michael’s Hospital engage in the identification, implementation, and evaluation of best practices through research. Both Courtney and Alison have had consultations with the IPBR team to refine their research questions and develop a research protocol.

“As a clinician, I am not trained to conduct research. I have found the support of IPBR to be tremendously valuable. Our different backgrounds complement each other which allows us to do valuable research.”
-Courtney Sas, social worker at St. Michael’s Hospital, Nephrology Unit



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