The Pathways Project

Changing the culture of kidney care to a more patient-centered approach

The Pathways Project is leading change in the use of supportive (palliative) care for patients with kidney disease. Currently, in the United States, the fast-growing population of patients receiving dialysis is older than 75 years. These older patients may be frail or sick with two or more chronic diseases, and dialysis may not extend their life and may reduce their quality of life. The Pathways Project is working towards the option of comprehensive medical care without dialysis for these patients, improving the overall quality of life and enhancing end-of-life care. The aim is to have care align with patient goals.

Leading Change

The Pathways Project developed a change package with 14 evidence-based best practice recommendations designed to improve supportive care delivery for patients with kidney disease. The ideal care system for seriously ill patients with kidney disease was defined. In this ideal patient-centered system:

  • Patient preferences, goals, and values are elicited and respected,
  • Patients receive treatment aligned with their goals, and
  • Patients and families receive the support, resources, and assistance to help them prepare for end-of-life care.

Over the next two years, the Pathway Project will collaborate with three ESRD Seamless Care Organizations (ESCOs), approximately 15 dialysis centers, in Nashville and New York City to spread supportive (palliative) care practices within dialysis organizations and their affiliated nephrology practices. Providers and organizations in the Pathway Project Collaborative will be given the tools, training, and resources to help them put supportive care into practice.

The Opportunity for Improvement

The Gordon and Betty Moore Foundation strives to promote pathbreaking scientific discovery and patient care improvement. To further this goal, the Foundation awarded funds in 2016 to launch the Pathways Project to develop a pathway for seriously ill patients with kidney disease to receive care consistent with their goals, especially for those who prefer medical management without dialysis and support at the end of life.

The Pathways Project is based at George Washington University School of Nursing in Washington, DC.