Which factor should be considered FIRST by the team planning for end-of-life care for a patient with end-stage renal disease?

• A. Family's role in care
• B. Reimbursement structure for care
• C. Evidence-based practice on end-of-life care
• D. Patient's values concerning end-of-life care

Answer: (D)

Centering the patient’s values and goals guides all decisions in end-of-life planning for someone with end-stage renal disease. When you start by asking what matters most to the patient—comfort, quality of life, or a desire to pursue life-prolonging treatments—the care plan can be built around those priorities, including discussions about prognosis and which interventions align with those goals.

The family’s role is important and often supports decisions, but it should reflect the patient’s own wishes. Reimbursement structures affect what’s feasible, but they don’t determine what the patient would choose. Evidence-based practices provide options and guidelines, yet they’re incorporated in a way that aligns with the patient’s goals rather than dictating care without regard to personal preferences.