Background: As one of the largest renal services to metropolitan and regional Victoria, North West Dialysis Service (NWDS) co-ordinates the care of ~630 dialysis patients and 320 patients in varying stages of Chronic Kidney Disease. NWDS convenes monthly metropolitan education sessions and seven rural sessions per annum.

Methods: In acknowledgement that not all patients registered with NWDS will proceed to dialysis or transplantation, and with growing evidence that quality of life for elderly patients or those with significant co-morbidities may be better preserved without dialysis, NWDS re-designed the patient education pathway in March 2003 (Ashby et al 2005). Embracing the concept of “Managing Kidney Failure” (MKF) as opposed to “Pre-Dialysis Education” involves introducing “not for dialysis”, with conservative medical management as a treatment choice for some patients. What is not well documented is how we express this option in the context of large patient forums, with audiences varying in age, co-morbidities, lifestyles and cultures.

Results: Of the patients attending MKF between November 2007 and November 2008 (age range 28 to 85 years), 5% have elected for conservative care, 71% have yet to commence dialysis, 20% proceeded to dialysis, 2% were pre-emptively transplanted and 2% passed away.

Conclusion: An investigation into introducing conservative management information to patients has borne unique patient reactions, raises questions about the methods of expressing this information in a diverse audience group, patient expectations of renal services and contemplates whether subsequent one-on-one patient education is a more appropriate forum in which to discuss palliative options.