Abstract: TH-PO0616
Shared Decision-Making About Vascular Access in CKD Care: An Embedded Case Study
Session Information
- CKD: Clinical - Guidelines, Biomarkers, Progression, Procedures, Outcomes, and More
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2202 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Elliott, Meghan J., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Kotani, Hana, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Ravani, Pietro, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- O'Connor, Caitrin, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Quinn, Robert R., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Donald, Maoliosa, University of Calgary, Calgary, Alberta, Canada
- Dumka, Heather, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Russon, Nazret G., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Fox, Danielle E., University of Calgary, Calgary, Alberta, Canada
- James, Matthew T., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Bohm, Clara, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
- Hundemer, Gregory L., University of Ottawa, Ottawa, Ontario, Canada
- MacRae, Jennifer M., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Lewis, Krystina B., University of Ottawa, Ottawa, Ontario, Canada
Background
Vascular access (VA) selection is a key component of preparing for hemodialysis. As guidelines emphasize individualized VA choice, understanding the role of shared decision-making (SDM) in routine chronic kidney disease (CKD) care can reveal how effectively patients are supported. Our objective was to examine how VA decisions are made in CKD clinic encounters, the extent to which SDM related to VA occurs, and the practices and processes that support or hinder SDM in this context.
Methods
We conducted an embedded multiple case study in two multidisciplinary clinics for people with CKD not receiving kidney replacement therapy in Calgary, Alberta. Cases were defined as encounters during which VA options were discussed, and subunits included the patients, caregivers, and clinicians involved in the encounter. Data included recorded clinical encounters and follow-up semi-structured interviews with observed participants. We conducted a thematic analysis of transcripts to explore decisional processes and contextual influences. The research team, including two patient partners, assessed the extent of SDM in each encounter using the OPTION-5 checklist, an observer-based measure of SDM.
Results
Across 25 observed clinical encounters where VA was discussed, the standardized mean SDM score was 67 (range 20-95), indicating moderate SDM with room to strengthen patient involvement. Analysis of interviews with 19 patients/caregivers and 21 multidisciplinary CKD clinicians highlighted trade-offs between providing comprehensive information about options and maintaining engagement in decision-making. The following themes characterize the conditions that shape VA-related SDM: (1) Sequencing and prioritization of decisions; (2) Responsiveness to patients' informational and emotional readiness; (3) Inconsistencies in approaches to presenting options; (4) Acknowledgement of uncertainty in CKD trajectory and access outcomes; and (5) Deliberate efforts to understand patient preferences.
Conclusion
SDM about VA occurs to a moderate extent in CKD clinic encounters and is greater in earlier stages of decision-making (e.g., building awareness and deliberation) than in later stages involving eliciting patient preferences and making decisions. Enhancing SDM will require decision and communication supports tailored to patients' readiness and life circumstances.