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Abstract: PO1039

Vascular Access Selection Among People Receiving Hemodialysis: A Qualitative Study of Shared Decision-Making

Session Information

Category: Dialysis

  • 703 Dialysis: Vascular Access

Authors

  • Elliott, Meghan J., University of Calgary, Calgary, Alberta, Canada
  • Ravani, Pietro, University of Calgary, Calgary, Alberta, Canada
  • Quinn, Robert R., University of Calgary, Calgary, Alberta, Canada
  • MacRae, Jennifer M., University of Calgary, Calgary, Alberta, Canada
  • Love, Shannan, University of Calgary, Calgary, Alberta, Canada
  • Oliver, Matthew J., University of Toronto, Toronto, Ontario, Canada
  • Hiremath, Swapnil, University of Ottawa, Ottawa, Ontario, Canada
  • James, Matthew T., University of Calgary, Calgary, Alberta, Canada
  • King--Shier, Kathryn M., University of Calgary, Calgary, Alberta, Canada
Background

The vascular access decision process for people receiving maintenance hemodialysis involves weighing the likelihood of having a functional access with its associated risks. How patient and clinician preferences are integrated alongside best evidence to make joint vascular access decisions is unclear. We aimed to explore how such decisions are made from the perspectives of patients, their caregivers, and their kidney care providers.

Methods

In this qualitative descriptive study, we purposively sampled patients receiving in-centre hemodialysis for >3 months via either an arteriovenous fistula or a central venous catheter, their informal caregivers, and their hemodialysis care providers. We conducted semi-structured interviews by telephone or in person with 19 patients, 2 caregivers, and 21 healthcare providers (8 nephrologists, 7 hemodialysis nurses, 6 vascular access nurses). We coded transcripts in duplicate and generated themes through an inductive, thematic analysis approach.

Results

Participants described a decisional hierarchy, whereby decisions regarding vascular access were predicated on upstream decisions (i.e., dialysis initiation, transplantation, home dialysis) that were preference sensitive and prioritized over vascular access type. Upon reaching a decision for hemodialysis, vascular access decision making was influenced by the following: 1) preferences for kidney replacement therapy, including anticipated timeline to transplantation or transition to home dialysis modalities; 2) urgency and timing of dialysis need, where urgent starts undermined expressed preferences; 3) limitations of individualized decisions, as when preferences and practicalities diverged; 4) occasions to re-visit the vascular access selection; and 5) availability of support for vascular access decision making and the decisional outcome.

Conclusion

Although patients and care providers prioritized upstream decisions, several influences on vascular access decision making were identified once the decision for hemodialysis was made. These findings can inform approaches to integrating shared decision making in dialysis and vascular access selection.