Shared decision-making in hemodialysis vascular access practice.
Shared decision-making in hemodialysis vascular access practice.
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DOI：
10.1016/j.kint.2021.05.041
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发表时间：
2021-10
影响因子：
19.6
通讯作者：
Lok CE
中科院分区：
文献类型：
--
作者：
Murea M;Grey CR;Lok CE
共享决策（SDM）是一个在二元患者-医生互动中的协作审议过程，医生借此告知患者所有可用治疗方案的利弊，并与患者就其首选治疗计划达成一致。在血液透析血管通路实践中，SDM提倡基于存在合理替代方案的审慎方法-即，动静脉瘘、动静脉移植物和中心静脉导管--这样患者就能够形成并分享关于通路选择的偏好。尽管具有伦理必要性，但SDM并未广泛应用于血液透析血管通路规划。内科医生和外科医生通常提供关于血管通路护理方法的以瘘管为中心的处方性建议。这种家长式的方法已经形成了长期持有的临床实践指南的方向，并通过与血液透析患者动静脉瘘的患病率相关的财务支付模式得到加强。越来越多的人意识到，最初似乎是医学和医学上合适的方法可能并不总是集中在每个人的护理目标上。临床医生对血管通路的建议通常没有充分考虑该决定的潜在受益的不确定性或该决定对患者生活质量的累积影响。在不断发展的医疗保健领域，是时候将血液透析血管通路的实践从分层的医生-患者方法转变为以患者为中心的护理。在这篇文章中，我们回顾了血管通路实践的现状，提出了为什么SDM是必要的血管通路规划的参数，审查障碍和潜在的解决方案，SDM的实施，并讨论未来的研究取决于一个有效的系统，医患参与决策的血液透析血管通路的做法。
Shared decision making (SDM) is a process of collaborative deliberation in the dyadic patient-physician interaction whereby physicians inform the patients about the pros and cons of all available treatment options and reach an agreement with the patients on their preferred treatment plan. In hemodialysis vascular access practice, SDM advocates a deliberative approach based on the existence of reasonable alternatives—i.e., arteriovenous fistula, arteriovenous graft, and central venous catheter—so that patients are able to form and share preferences about access options. In spite of its ethical imperative, SDM is not broadly applied in hemodialysis vascular access planning. Physicians and surgeons commonly deliver prescriptive fistula-centered recommendations concerning the approach to vascular access care. This paternalistic approach has been shaped by directions from long-held clinical practice guidelines and is reinforced by financial payment models linked with the prevalence of arteriovenous fistula in patients on hemodialysis. Awareness is growing that what may have initially seemed a medically- and surgically-appropriate approach might not always be focused on each individual’s goals of care. Clinician’s recommendations for vascular access often do not sufficiently consider the uncertainty surrounding the potential benefits of the decision or the cumulative impact of the decision on patient’s quality of life. In the evolving healthcare landscape, it is time for the practice of hemodialysis vascular access to shift from a hierarchical doctor-patient approach to patient-centered care. In this article we review the current state of vascular access practice, present arguments why SDM is necessary in vascular access planning, review barriers and potential solutions to SDM implementation, and discuss future research contingent upon an effective system of physician-patient participative decision making in hemodialysis vascular access practice.
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