Abstract: SA-PO0440
A Qualitative Study of Shared Decision-Making in Vascular Access Planning: Emerging Themes from the Nephrology Provider Perspective
Session Information
- Dialysis: Vascular Access
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 803 Dialysis: Vascular Access
Authors
- Liu, Andrea Yu-Ling, The University of Chicago, Chicago, Illinois, United States
- Ryno, Jacob, The University of Chicago, Chicago, Illinois, United States
- Chikoti, Rishika, The University of Chicago, Chicago, Illinois, United States
- Hammes, Mary S., The University of Chicago, Chicago, Illinois, United States
- Angelos, Peter, The University of Chicago, Chicago, Illinois, United States
- Skolarus, Ted, The University of Chicago, Chicago, Illinois, United States
Background
The National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative guidelines for vascular access underwent a fundamental shift in 2019 from a one-size-fits-all “fistula first, catheter last” approach to an individualized “right access for the right patient” approach. This new approach uses shared decision-making (SDM) to determine the most appropriate vascular access for hemodialysis. Shared decision-making is patient-centered and associated with improved patient satisfaction and quality of care. However, the degree to which SDM is utilized and its effectiveness as part of vascular access care remain unclear.
Methods
Guided by the Consolidated Framework for Implementation Research (CFIR) 2.0, we conducted semi-structured qualitative interviews with nephrology clinicians involved in hemodialysis care on the South Side of Chicago from December 2024 through May 2025. We transcribed the interviews and 3 independent researchers systematically coded and mapped the data to relevant CFIR domains and constructs for thematic analysis to understand barriers and facilitators of SDM in vascular access care.
Results
We interviewed 12 providers (7 nephrologists, 5 advanced practice providers). We identified significant barriers and facilitators to implementation of SDM in vascular access planning mostly within the Implementation Process domain. Emerging themes from the provider perspective included: 1) patient fears and perceptions of dialysis limiting their ability to participate in SDM, 2) trust-building as essential for effective SDM (e.g., “Not everybody believes me. I don't look like my patients, I don't sound like my patients…after I've been working with people for a while, that trust gets built.”), and 3) peer mentorship mitigating patient hesitancy and facilitating SDM engagement.
Conclusion
Nephrology providers perceived barriers to effective SDM implementation to be multifactorial and possibly modifiable. Interventions targeting barriers (patient fears, trust-building) and leveraging facilitators (peer mentors) may improve SDM implementation and effectiveness in vascular access care. Further research on patient perspectives regarding SDM appears warranted to better inform intervention selection and tailoring.
Funding
- NIDDK Support