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Abstract: PO1038

Alignment Between Patient and Provider Perspectives on Hemodialysis Vascular Access Decision-Making: A Qualitative Study

Session Information

Category: Dialysis

  • 703 Dialysis: Vascular Access

Authors

  • Schneider, Angela Rebecca, University of Calgary, Calgary, Alberta, Canada
  • Ravani, Pietro, University of Calgary, Calgary, Alberta, Canada
  • King--Shier, Kathryn M., University of Calgary, Calgary, Alberta, Canada
  • Quinn, Robert R., University of Calgary, Calgary, Alberta, Canada
  • MacRae, Jennifer M., 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
  • Elliott, Meghan J., University of Calgary, Calgary, Alberta, Canada
Background

Recent updates to the KDOQI Clinical Practice Guideline for Vascular Access emphasize attaining the “right access, in the right patient, at the right time, for the right reasons”. Yet, how patients, their caregivers, and healthcare providers integrate medical factors with care preferences in patient-centered vascular access decision making is unknown. We sought to explore the extent to which these diverse perspectives align in hemodialysis vascular access selection.

Methods

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

Results

While participants across roles shared perspectives related to vascular access decision making, we identified several areas where views diverged. Participants acknowledged the importance of decisional timing and readiness, the iterative nature of decision making, and a desire for vascular access selection to be a shared decision. Perspectives differed in the following key aspects: 1) priorities for vascular access type – providers’ preferences for fistulas and physiological optimization contrasted with patients’ focus on quality of life; 2) provider involvement in the decision – patients desired guidance from their trusted providers, whereas care providers tried to avoid unduly influencing the decision; 3) informational needs – tools and resources offered by the care team may not meet patients’ need for pragmatic, experiential knowledge about vascular access options.

Conclusion

While patients and providers identified common perspectives related to the nature and timing of the vascular access decision, conflicting priorities and preferences may impact the decisional outcome. This study highlights opportunities to address decisional conflicts and enable shared decision making in vascular access selection.