Construction of the ESKD Life Plan

项目摘要/摘要 终末期肾病血液透析患者血管通路的选择 依赖可以强烈地影响血管通路寿命、是否需要修订程序、 重复通道手术和住院治疗，进而影响患者的生活质量。为了解决这个问题， 等待国家肾脏基金会透析结果质量倡议(K-DOQI)临床更新 血管通路实践指南建议构建和定期更新个性化的 ESKD生命--为每个患者制定计划。这样的血管通路人寿计划包含了一个针对所有 在患者依赖血液透析的余生中，为个别患者提供血管通道。生活-- 计划将由提供者团队与患者一起在一个多学科团队中制定 框架。然而，实施K-DOQI推荐的人寿计划可能需要相当大的基础设施 并可能面临巨大的障碍，因为这样的ESKD生命计划的概念对患者来说是全新的 和提供者。拟议研究的目标是确定提供者、患者和相关人员的 利益相关者对多学科提供者-患者讨论应如何进行的态度和偏好 指挥。 为了克服实施K-DOQI指南的障碍，相关患者和提供者将共同参与 为ESKD生命计划实施开发工具包，侧重于患者参与、共享决策 以及多学科协作的障碍和促进者。第一，质化的个体半结构化 将使用对大约55名患者和提供者的采访，使)能够不受限制地探索 主题；以及b)参与者用自己的话表达态度和偏好。然后将使用这些数据 开发原型生命计划实施工具包，以适应不同的患者偏好和 医疗保健系统，并执行其初始现场测试和同行审查。这将通知未来赠款资助的 实施测试，以确定工具包在支持和促进向 新的血管通路模式。 具体目标是： 1：确定相关患者和提供者对学位和医疗服务提供者的态度和偏好 他们自己参与ESKD生命计划的共同决策和发展的性质。 2：开发和执行生命计划实施工具包的初始现场测试和同行审查，以增强 患者参与血管通路的共享决策过程，并为提供者提供方法 克服多学科团队方法的挑战。

PROJECT SUMMARY/ABSTRACT Decisions about vascular access in patients with end-stage kidney disease (ESKD) who are hemodialysis dependent can strongly influence clinical outcomes of vascular access longevity, need for revision procedures, repeat access operations and hospitalizations which in turn affect patients' quality of life. Addressing this, the pending update of the National Kidney Foundation Dialysis Outcomes Quality Initiative (K-DOQI) Clinical Practice Guideline for Vascular Access recommends construction and regular update of an individualized ESKD Life-Plan for each patient. Such vascular access Life-Plans encompass a specific plan for all of the vascular accesses for an individual patient for the remainder of the patient’s hemodialysis-dependent life. Life- Plans are to be developed by the provider team in conjunction with the patient, within a multidisciplinary team framework. However, implementing K-DOQI-recommended Life-Plans can require considerable infrastructure and may face significant barriers, as the concept of such an ESKD Life-Plan is entirely novel both to patients and providers. The goal of the proposed research is to ascertain providers', patients' and relevant stakeholders’ attitudes and preferences for how the multidisciplinary provider-patient discussions should be conducted. To overcome barriers to implementing K-DOQI guidelines, relevant patients and providers will be engaged in co- developing a toolkit for ESKD Life-Plan implementation focused on patient engagement, shared decision-making and barriers and facilitators to multidisciplinary collaboration. First, qualitative individual semi-structured interviews with approximately 55 patients and providers will be used, enabling a) unrestricted exploration of the topic; and b) participants to express attitudes and preferences in their own words. These data will then be used to develop a prototype Life-Plan implementation toolkit that accommodates diverse patient preferences and healthcare systems, and perform its initial field testing and peer review. This will inform future grant-funded implementation testing to determine the toolkit's efficacy and utility in enabling and facilitating transition to the new vascular access paradigm. The Specific Aims are to: 1: Determine the attitudes and preferences of relevant patients and providers with respect to degree and nature of their own involvement in shared decision-making and development of the ESKD Life-Plan. 2: Develop and perform initial field testing and peer review of a Life-Plan implementation toolkit that empowers patients to engage in the vascular access shared decision-making process and offers methods to providers to overcome challenges of the multidisciplinary team approach.