Holistic Palliative Care for End-Stage Renal Disease Patients Undergoing Non-Dialysis Treatment: A Case Study


  • กัลปังหา โชสิวสกุล วิทยาลัยพยาบาลบรมราชชนี กรุงเทพ
  • แสงทอง ธีระทองคำ


holistic palliative care, end-stage renal disease, non-dialysis treatment


End-stage renal disease (ESRD) incapacitates the kidney’s filtering function, resulting in accumulation of waste products in the body. The disease’s progression to the end stage is accompanied by an increase in severity of symptoms. In this stage, the patients suffer from agitation and pain, which affect their physical, mental, emotional, and social abilities. This article presents a case study of end-stage renal disease patients who chose non-dialysis treatment and experienced severe symptomatic progress. The patients, whose symptoms included nausea, vomiting, loss of appetite, fatigue, hyperventilation, edema, and stupor, were taken by their family members to hospital each time a symptomatic change occurred. However, the mismatch between the patients’ needs and their family members’ expectations affected both parties and complicated the caregiving process, both in terms of retarding the disease’s progression and increasing the families’ readiness to care for the patients during their terminal stage.


What the ESRD patients needed was a holistic palliative care programme. The implementation of such a programme, which was systematically co-designed by multidisciplinary teams and the patients’ family caregivers, required the skills and expertise of advanced registered nurses. The programme was based on a five-step procedure: 1) assessment and analysis of patients; 2) planning for retardation of renal disease progression; 3) management of symptomatic changes; 4) process of participatory decision making; and 5) provision of holistic care. This programme produced good-quality care outcomes, and allowed peaceful, fully dignified departure from this world whilst filling the families with pride in the deceased’s decision and satisfaction with the caregiving service.


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How to Cite

โชสิวสกุล ก, ธีระทองคำ แ. Holistic Palliative Care for End-Stage Renal Disease Patients Undergoing Non-Dialysis Treatment: A Case Study. TJNC [Internet]. 2020 Oct. 6 [cited 2022 Sep. 30];35(4):5-17. Available from: https://he02.tci-thaijo.org/index.php/TJONC/article/view/240579