Nurse-led shared decision-making for hemodialysis vascular access: a randomized controlled trial

To evaluate the efficacy of a nurse-led stepwise shared decision-making (SDM) model, guided by the Decisional Conflict Scale (DCS), for vascular access management in hemodialysis patients.

In this randomized controlled trial, 120 hemodialysis patients requiring vascular access establishment or reconstruction were randomly allocated (1:1) via block randomization to an experimental or control group (n = 60 each). Control patients received standard health education. The experimental group received a nurse-led SDM intervention integrating DCS assessment and tailored decision aids. The primary outcome was the change in decisional conflict, measured by the DCS score. Secondary outcomes comprised preoperative state anxiety, decision satisfaction, arteriovenous fistula (AVF) selection rates, and 6-month postoperative complications. Post-intervention continuous outcomes were analyzed using Analysis of Covariance (ANCOVA) to adjust for baseline covariates.

Post-intervention, the experimental group demonstrated significantly lower decisional conflict (adjusted mean difference [AMD]: -18.74, 95% CI [-25.58, -11.91], p < 0.001, partial eta-squared = 0.20) and preoperative anxiety (AMD: -5.23, 95% CI [-6.31, -4.16], p < 0.001, partial eta-squared = 0.44) than the control group. Furthermore, the experimental cohort exhibited higher decision satisfaction (AMD: 3.69, 95% CI [2.32, 5.06], p < 0.001, partial eta-squared = 0.19), a higher AVF selection rate (80.0% vs. 58.3%, p = 0.022), and significantly lower rates of 6-month postoperative complications.

The nurse-led shared decision-making model significantly reduces decisional conflict and state anxiety while promoting AVF selection when adjusting for baseline covariates. By utilizing a structured, stepwise approach, this model supports objective, patient-centered vascular access decisions in the hemodialysis population.