Shared decision making in vascular access selection
Rationale & objective: Collaborative approaches to vascular access (VA) selection are being increasingly encouraged to elicit patients’ preferences and priorities where no unequivocally superior choice exists. We aimed to explore how patients, their caregivers, and clinicians integrate principles of shared decision-making when engaging in VA discussions.
Study design: Qualitative description.
Setting: & Participants: Semi-structured interviews with a purposive sample of patients, their caregivers, and clinicians from outpatient hemodialysis programs in Alberta, Canada.
Analytical approach: We used a thematic analysis approach to inductively code transcripts and generate themes to capture key concepts related to VA shared decision-making across participant roles.
Results: Forty-two individuals (19 patients, 2 caregivers, 21 clinicians) participated in this study. Participants identified how access-related decisions follow a series of major decisions about kidney replacement therapy and care goals which influence VA preferences and choice. VA shared decision-making was strengthened through integration of VA selection with dialysis-related decisions and timely, tailored, and balanced exchange of information between patients and their care team. Participants described how opportunities to revisit the VA decision before and after dialysis initiation helped prepare patients for their access and encouraged ongoing alignment between patients’ care priorities and treatment plans. Where shared decision-making was undermined, hemodialysis via a catheter ensued as the most readily available VA option.
Limitations: Our study was limited to patients and clinicians from hemodialysis care settings and included few caregiver participants.
Conclusions: Findings suggest that earlier, or upstream, decisions about kidney replacement therapies influence how and when VA decisions are made. Repeated VA discussions that are integrated with other higher-level decisions are needed to promote VA shared decision-making and preparedness.
Elliott MJ, Ravani P, Quinn RR, Oliver MJ, Love Mslp S, MacRae J, Hiremath S, Friesen S, James MT, King-Shier KM. Patient and Clinician Perspectives on Shared Decision Making in Vascular Access Selection: A Qualitative Study. Am J Kidney Dis. 2022 Jul 15:S0272-6386(22)00777-6. doi: 10.1053/j.ajkd.2022.05.016. Epub ahead of print. PMID: 35870570.