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.
Approach:
Study Design: A randomized controlled trial involving 120 hemodialysis patients requiring vascular access establishment or reconstruction, allocated to experimental or control groups.
Intervention: The experimental group received a nurse-led SDM intervention integrating DCS assessment and tailored decision aids, while the control group received standard health education.
Outcome Measures: Primary outcome was change in decisional conflict (DCS score). Secondary outcomes included preoperative anxiety, decision satisfaction, AVF selection rates, and 6-month postoperative complications.
Statistical Analysis: Post-intervention outcomes were analyzed using ANCOVA to adjust for baseline covariates.
Key Findings:
The experimental group showed significantly lower decisional conflict (AMD: −18.74, p < 0.001) and preoperative anxiety (AMD: −5.23, p < 0.001) compared to the control group.
Higher decision satisfaction was reported in the experimental group (AMD: 3.69, p < 0.001).
The AVF selection rate was higher in the experimental group (80.0% vs. 58.3%, p = 0.022).
The experimental group had significantly lower rates of 6-month postoperative complications.
Interpretation:
The nurse-led shared decision-making model significantly reduces decisional conflict and state anxiety while promoting AVF selection in hemodialysis patients.
Limitations:
Single-center study may limit generalizability.
Potential biases in self-reported measures.
Conclusion:
The structured, stepwise approach of the nurse-led SDM model supports objective, patient-centered vascular access decisions in the hemodialysis population.
