For more than 2 decades, nephrologists and patients have recognized the key role nephrology advanced practice providers have played in the care of patients with chronic kidney disease. The National Kidney Foundation Council for Advanced Practice Providers (CAPP) conducts a biannual survey addressing the roles of nephrology APPs, and reveals most APPs practice within CKD clinics, dialysis units, and pre- and post-transplant. There is not yet mention of supportive care practices; however, many APPs deliver supportive care to patients on dialysis, those who have opted to forego dialysis and those within the kidney palliative care space. As predicted more than 20 years ago, APPs have lived up to their potential and certainly proven their worth in both nephrology and palliative care, supporting person-centered care and improving quality of life and well-being for patients with CKD and their families.

After two years of the End-Stage Renal Disease Treatment Choices (ETC) model, researchers reported that the model was not associated with an increase in the proportion of patients receiving home dialysis or a transplant despite financial incentives for these modalities. Writing in Healio/Nephrology News and Issues (NNI), nephrologist Jay Wish, MD, who is chair of the NNI Advisory Board said that the model is a “bust” is no surprise. He said that ETC missed the mark because it rewarded the wrong thing. Instead of rewarding nephrologists for patient-centeredness and engaging their patients in shared decision-making, the model incentivized what the patient chose, not the process in which they are fully informed of the advantages and disadvantages of each kidney failure treatment choice and able to decide on what’s most important to them. ExPAND does precisely what Dr. Wish advocates: trains nephrology clinicians in the process of shared decision-making and resources them with patient-friendly decision aids and communication skills so that they are comfortable and confident in discussing all kidney failure treatment choices with their patients. In addition, for those patients who choose active medical care without dialysis, ExPAND assists nephrology practices to build the infrastructure to support patients and their families with pain and symptom management and advance care planning. The ExPAND team is optimistic that participating nephrology practices and their patients will see real benefits from implementing robust shared decision-making in the process in which patients decide on a kidney failure treatment option. Training for clinicians in ExPAND starts this week!