Table 1.

Triggers for serious illness conversations in ESRD

Before dialysis
 Clinical triggers
  Not surprised in answer to surprise question
  High likelihood (Tangri score) of progression to ESRD
  Dialysis modality teaching referral
  Access referral
  Access placement
  Transplant referral
  Recurrent or prolonged hospitalizations
  Changes in function or dependence
  Sentinel events or indicators (falls, poor appetite, falling albumin, or weight loss)
 Patient or family request
After beginning dialysis
 Clinical triggers
  Not surprised in answer to surprise question
  Access procedures
  Recurrent or prolonged hospitalizations
  Changes in function or dependence
  Sentinel events or indicators (falls, poor appetite, falling albumin, weight loss or change in interdialytic weight gain, or falling BP)
 Time-based triggers
  Admission to the dialysis unit
  After 3 mo on dialysis
  Annually
 Patient or family request