March 19, 2025

Priorities of dialysis patients and care providers when planning vascular access

A series of interviews with dialysis patients, caregivers, and health care providers sheds light on their priorities when it comes to planning vascular access (VA) for dialysis. The results suggest great variability in preferences both across and within these groups.  

People who require dialysis need specialized VA points created, such as a fistula or catheter port, if they are to receive hemodialysis. Each VA option has pros and cons, and it is important that patients and care providers work together using a shared decision-making approach to ensure that the chosen VA option aligns with the patient’s priorities and preferences. 

To gain a better understanding of VA preferences, Angela R. Schneider and colleagues conducted semi-structured interviews with 19 patients receiving maintenance hemodialysis, two caregivers, and 21 health care providers, and analyzed their feedback for key themes. The results show a lot of variation in preferences, even within groups. However, both patients and providers emphasized the need to adapt discussions about VA to patients’ needs, in terms of both the type of information provided and the format used to deliver it. Notably, some patients still lack enough information about VA options by the time a decision needs to be made, despite repeated discussions with their care provider.   

In general, patients tended to place higher priority on their quality of life when making VA decisions, whereas health care providers tended to focus on optimized and complication-free delivery of dialysis. The authors note that although these priorities are not mutually exclusive, for some patients prioritizing access functionality and longevity comes at the cost of pain, procedures, and complications. The results of this qualitative descriptive study could help inform shared decision-making efforts moving forward, say the authors.