Upstream kidney replacement therapy decisions influence vascular access decisions
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Interviews revealed earlier decisions about kidney replacement therapies impact how and when patients, caregivers and clinicians make vascular access decisions.
“As shared decision-making is a necessarily collaborative endeavor, it is imperative to examine processes by which patients and clinicians share information, preferences and priorities about [vascular access (VA)] and arrive at mutually agreeable treatment plans,” J. Elliott, MD, MSc, an assistant professor from the departments of medicine and community health sciences in the Cummings school of medicine at the University of Calgary in Canada, and colleagues wrote. “We aimed to explore how patients receiving hemodialysis, their caregivers, and clinicians integrate principles of shared decision-making when engaging in VA discussions. Understanding how these individuals perceive VA selection influences may help optimize shared decision-making processes and patients’ care experiences.”
In a qualitative study, researchers conducted semi-structured interviews with 19 patients, two caregivers and 21 clinicians to determine different perspectives of shared decision-making when engaging in VA discussion.
Interviews consisted of open-ended questions focused on VA selection and follow-up questions based on concepts raised. All interviews were recorded, except for one that an investigator took notes on.
Researchers utilized thematic analyses to inductively code transcripts and create themes of key concepts across participant roles.
Analyses revealed how major decisions about kidney replacement therapy and care goals precede access-related decisions. Participants shared that shared VA decision-making could be strengthened through “timely, tailored, and balanced” informative conversations between patients and their caregivers. Additionally, many patients said that revisiting the VA decision before and after starting dialysis helped prepare them for their access.
“Upon acceptance of kidney replacement therapy, patients were faced first with decisions related to transplantation and/or dialysis modality preferences, followed by VA selection once hemodialysis had been identified as the preferred or most appropriate treatment option. Upstream priorities about kidney replacement therapies influenced how patients and clinicians engaged in collaborative discussions about VA and perceived eligibility for a specific VA type,” Elliot and colleagues wrote. “As VA decisions were conditional on higher-order decisions, participants valued individualized information exchange at each decision point according to patients’ readiness, priorities and goals.”
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