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Published on: May 31, 2022
Nurse-led shared decision-making for hemodialysis vascular access: a randomized controlled trial
Fan Yang1, Wenhua Yang1, Fangfang Lu1
1Department of Hemodialysis, Linquan County People's Hospital, Fuyang, China.
Frontiers in Medicine
|July 23, 2026
Summary
A nurse-led shared decision-making model significantly reduced decisional conflict and anxiety in hemodialysis patients. This approach improved patient satisfaction and arteriovenous fistula selection rates, enhancing vascular access management.
Area of Science:
- Nephrology
- Nursing
- Health Services Research
Background:
- Vascular access is critical for hemodialysis patients, yet decisions regarding its establishment or reconstruction can cause significant patient uncertainty.
- Shared decision-making (SDM) models aim to involve patients more actively in healthcare choices, potentially improving outcomes.
- The Decisional Conflict Scale (DCS) is a validated tool for measuring patient uncertainty in decision-making.
Purpose of the Study:
- To evaluate the effectiveness of a nurse-led stepwise shared decision-making (SDM) model using the Decisional Conflict Scale (DCS) for hemodialysis patients' vascular access management.
- To assess the impact of the SDM intervention on decisional conflict, anxiety, decision satisfaction, arteriovenous fistula (AVF) selection, and postoperative complications.
Main Methods:
- A randomized controlled trial involving 120 hemodialysis patients was conducted.
- Patients were randomized to either a standard health education control group or an experimental group receiving a nurse-led SDM intervention.
- The intervention integrated DCS assessment and tailored decision aids. Outcomes were analyzed using ANCOVA.
Main Results:
- The experimental group showed significantly lower decisional conflict (p < 0.001) and preoperative anxiety (p < 0.001) compared to the control group.
- Higher decision satisfaction (p < 0.001) and a greater AVF selection rate (80.0% vs. 58.3%, p = 0.022) were observed in the intervention group.
- The nurse-led SDM model was associated with significantly lower 6-month postoperative complications.
Conclusions:
- A nurse-led stepwise SDM model effectively reduces decisional conflict and state anxiety in hemodialysis patients undergoing vascular access decisions.
- This model promotes patient-centered choices, increases arteriovenous fistula selection, and improves decision satisfaction.
- The structured SDM approach supports informed and objective vascular access decision-making for hemodialysis patients.
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