Part 4 in this series of brief video vignettes where, two nephrologists, Dr. Matt Esson of Western Nephrology Associates and Dr. Alvin Moss of West Virginia University, discuss some of Matt's challenging cases and how use of communication skills can promote shared decision-making and goals of care discussions, including the option of medical management without dialysis when appropriate, with seriously ill patients with chronic and end-stage kidney disease and their families. The four cases and discussion are ideal for introducing nephrology trainees and clinicians to key primary palliative care topics.

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