Vascular Access Selection Among People Receiving Hemodialysis: A Qualitative Study of Shared Decision-Making
Bibliographic record
Abstract
Background: The vascular access decision process for people receiving maintenance hemodialysis involves weighing the likelihood of having a functional access with its associated risks. How patient and clinician preferences are integrated alongside best evidence to make joint vascular access decisions is unclear. We aimed to explore how such decisions are made from the perspectives of patients, their caregivers, and their kidney care providers. Methods: In this qualitative descriptive study, we purposively sampled patients receiving in-centre hemodialysis for >3 months via either an arteriovenous fistula or a central venous catheter, their informal caregivers, and their hemodialysis care providers. We conducted semi-structured interviews by telephone or in person with 19 patients, 2 caregivers, and 21 healthcare providers (8 nephrologists, 7 hemodialysis nurses, 6 vascular access nurses). We coded transcripts in duplicate and generated themes through an inductive, thematic analysis approach. Results: Participants described a decisional hierarchy, whereby decisions regarding vascular access were predicated on upstream decisions (i.e., dialysis initiation, transplantation, home dialysis) that were preference sensitive and prioritized over vascular access type. Upon reaching a decision for hemodialysis, vascular access decision making was influenced by the following: 1) preferences for kidney replacement therapy, including anticipated timeline to transplantation or transition to home dialysis modalities; 2) urgency and timing of dialysis need, where urgent starts undermined expressed preferences; 3) limitations of individualized decisions, as when preferences and practicalities diverged; 4) occasions to re-visit the vascular access selection; and 5) availability of support for vascular access decision making and the decisional outcome. Conclusions: Although patients and care providers prioritized upstream decisions, several influences on vascular access decision making were identified once the decision for hemodialysis was made. These findings can inform approaches to integrating shared decision making in dialysis and vascular access selection.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.020 | 0.030 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.016 | 0.017 |
| Scholarly communication | 0.006 | 0.008 |
| Open science | 0.003 | 0.009 |
| Research integrity | 0.003 | 0.005 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".