Decisions about vascular access in patients with end-stage kidney disease (ESKD) who are hemodialysis dependent can strongly influence clinical outcomes of vascular access longevity, need for revision procedures, repeat access operations and hospitalizations which in turn affect patients' quality of life. Addressing this, the pending update of the National Kidney Foundation Dialysis Outcomes Quality Initiative (K-DOQI) Clinical Practice Guideline for Vascular Access recommends construction and regular update of an individualized ESKD Life-Plan for each patient. Such vascular access Life-Plans encompass a specific plan for all of the vascular accesses for an individual patient for the remainder of the patient?s hemodialysis-dependent life. Life- Plans are to be developed by the provider team in conjunction with the patient, within a multidisciplinary team framework. However, implementing K-DOQI-recommended Life-Plans can require considerable infrastructure and may face significant barriers, as the concept of such an ESKD Life-Plan is entirely novel both to patients and providers. The goal of the proposed research is to ascertain providers', patients' and relevant stakeholders? attitudes and preferences for how the multidisciplinary provider-patient discussions should be conducted. To overcome barriers to implementing K-DOQI guidelines, relevant patients and providers will be engaged in co- developing a toolkit for ESKD Life-Plan implementation focused on patient engagement, shared decision-making and barriers and facilitators to multidisciplinary collaboration. First, qualitative individual semi-structured interviews with approximately 55 patients and providers will be used, enabling a) unrestricted exploration of the topic; and b) participants to express attitudes and preferences in their own words. These data will then be used to develop a prototype Life-Plan implementation toolkit that accommodates diverse patient preferences and healthcare systems, and perform its initial field testing and peer review. This will inform future grant-funded implementation testing to determine the toolkit's efficacy and utility in enabling and facilitating transition to the new vascular access paradigm.
The Specific Aims are to: 1: Determine the attitudes and preferences of relevant patients and providers with respect to degree and nature of their own involvement in shared decision-making and development of the ESKD Life-Plan. 2: Develop and perform initial field testing and peer review of a Life-Plan implementation toolkit that empowers patients to engage in the vascular access shared decision-making process and offers methods to providers to overcome challenges of the multidisciplinary team approach.
Decisions about vascular access in patients with end-stage kidney disease (ESKD) who are hemodialysis dependent can strongly influence clinical outcomes of vascular access longevity, need for revision procedures, repeat access operations and hospitalizations which in turn affect patients' quality of life. Addressing this, the pending update of the National Kidney Foundation Dialysis Outcomes Quality Initiative (K-DOQI) Clinical Practice Guideline for Vascular Access recommends construction and regular update of an individualized ESKD Life-Plan for each patient. The proposed research will ascertain stakeholder attitudes and preferences towards the multidisciplinary team structure and feasible, acceptable methods for patients to engage and collaborate in developing individualized ESKD Life-Plans in order to develop tools that will optimize the patient and provider experience.
