scholarly journals Shared-decision making in hemodialysis vascular access practice

Author(s):  
Mariana Murea ◽  
Carl R. Grey ◽  
Charmaine E. Lok
Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0002882021
Author(s):  
Mariana Murea ◽  
Karen Woo

Vascular access planning is critical in the management of patients with advanced kidney disease who elect hemodialysis for kidney replacement therapy. Policies put in place more than two decades ago attempted to standardize vascular access care around the model of optimal-i.e, arteriovenous fistula-and least preferred-i.e., central venous catheter-type of access. This homogenized approach to vascular access care emerged ineffective in the ever increasingly heterogeneous and complex dialysis population. The most recent vascular access guidelines acknowledge limitations of standardized care and encourage tailoring vascular access care based on patient and disease characteristics. In this article we discuss available literature in support of patient-tailored access care based on differences in vascular access outcomes by biologic and social factors-age, sex and race. Further, we draw attention to the overlooked dimension of patient-reported preferences and shared decision making in the practice of vascular access planning. We discuss milestones to overcome as requisite steps to implement effective shared decision making in vascular access care. Finally, we take into consideration local practice co-factors as major players in vascular access fate. We conclude that a personalized approach to hemodialysis vascular access will require dynamic care specifically relevant to the individual based on biological factors, fluctuating clinical needs, values and preferences.


2014 ◽  
Vol 21 (1) ◽  
pp. 15-23 ◽  
Author(s):  
Helen Pryce ◽  
Amanda Hall

Shared decision-making (SDM), a component of patient-centered care, is the process in which the clinician and patient both participate in decision-making about treatment; information is shared between the parties and both agree with the decision. Shared decision-making is appropriate for health care conditions in which there is more than one evidence-based treatment or management option that have different benefits and risks. The patient's involvement ensures that the decisions regarding treatment are sensitive to the patient's values and preferences. Audiologic rehabilitation requires substantial behavior changes on the part of patients and includes benefits to their communication as well as compromises and potential risks. This article identifies the importance of shared decision-making in audiologic rehabilitation and the changes required to implement it effectively.


2004 ◽  
Author(s):  
P. F. M. Stalmeier ◽  
M. S. Roosmalen ◽  
L. C. G. Josette Verhoef ◽  
E. H. M. Hoekstra-Weebers ◽  
J. C. Oosterwijk ◽  
...  

2013 ◽  
Author(s):  
Shirley M. Glynn ◽  
Lisa Dixon ◽  
Amy Cohen ◽  
Amy Drapalski ◽  
Deborah Medoff ◽  
...  

2018 ◽  
Vol 09 (06) ◽  
pp. 250-252
Author(s):  
Rainer Bubenzer

Auch in der Onkologie hat das Thema Patientenbeteiligung zunehmend an Bedeutung gewonnen. Ein häufig genanntes Mantra dazu lautet: Viele Patienten wünschen sich eine aktivere Rolle bei der eigenen Gesundheitsversorgung, am besten auf „Augenhöhe“. Ein Ansatz, der solche Wünsche berücksichtigt, ist die partizipative Entscheidungsfindung (PEF, shared-decision-making). Auch auf gesundheitspolitischer Ebene spielt PEF eine wachsende Rolle, wird z. B. im Rahmen des Nationalen Krebsplans spezifisch gefördert (►siehe Kasten). Ob und wieweit diese ambitionierten Ziele in der Onkologie in der Versorgungswirklichkeit angekommen sind, war eines der Themen beim 17. Deutschen Kongress für Versorgungsforschung in Berlin. Es zeigte sich: PEF ist in vielen Bereichen der Onkologie noch längst nicht angekommen.


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