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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 (SDM) model effectively reduced decisional conflict and anxiety in hemodialysis patients. This approach improved patient satisfaction and arteriovenous fistula selection rates, leading to better outcomes.
Area of Science:
- Nephrology
- Nursing
- Health Psychology
Background:
- Vascular access is crucial for hemodialysis patients, with decisions impacting long-term outcomes.
- Shared decision-making (SDM) models can empower patients in complex healthcare choices.
- The Decisional Conflict Scale (DCS) is a validated tool for assessing patient uncertainty in decision-making.
Purpose of the Study:
- To evaluate the efficacy of a nurse-led stepwise shared decision-making (SDM) model, using the Decisional Conflict Scale (DCS), for vascular access management in hemodialysis patients.
- To assess the impact of the SDM model on patient anxiety, satisfaction, and choice of vascular access.
- To determine the effect of the SDM intervention on postoperative complications within six months.
Main Methods:
- A randomized controlled trial involving 120 hemodialysis patients requiring vascular access.
- Patients were randomized to either a standard health education control group or an experimental group receiving nurse-led SDM with decision aids.
- Primary outcome: change in DCS score; Secondary outcomes: anxiety, satisfaction, AVF selection, and 6-month complications. ANCOVA was used for analysis.
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 arteriovenous fistula (AVF) selection rate (80.0% vs. 58.3%, p = 0.022) were observed in the SDM group.
- The SDM intervention was associated with significantly lower rates of 6-month postoperative complications.
Conclusions:
- The nurse-led SDM model significantly reduces decisional conflict and anxiety in hemodialysis patients undergoing vascular access decisions.
- This structured, stepwise approach enhances patient-centered decision-making, promoting higher AVF selection rates.
- The intervention supports informed choices and positively impacts clinical outcomes, including reduced postoperative complications.
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