Abstract
Background and aims: Recent clinical practice guidelines in hemodialysis vascular access recommend flexibility in treatment options and a patient-centered, collaborative approach. We explored patient perspectives on the indicators of quality in healthcare services for dialysis vascular access in New Zealand, to inform quality improvement aligned with guideline recommendations.
Methods: Adults with kidney failure who had experienced health services for hemodialysis vascular access were recruited nationally through website advertisement or face-to-face in two nephrology units, with purposive inclusion based on age, gender, ethnicities and kidney failure treatment modality. Semi-structured interviews were analyzed inductively then deductively to identify themes relating specifically to health service quality.
Results: Twenty-six patients participated in interviews. Fifteen participants identified as women and six as New Zealand Māori (Indigenous Peoples of New Zealand). Three themes and related subthemes were identified: Clinical process indicators (healthcare service integration, timely clinical assessment and intervention, opportunities to discuss individual access management, expert vascular access nursing care, psychological support), increasing healthcare literacy (availability of informational resources, clinician-supported learning, peer-to-peer learning, clear explanations of procedural details and expected results, preparedness for vascular access care), empathetic communication (clinicians understanding of patients’ experiences, clinician responsiveness to patient self-advocacy, inclusion in decision-making). The overarching theme was the importance of trusting partnerships in vascular access healthcare delivery.
Conclusions: Participants reported that quality in dialysis vascular access health services included effective clinical processes, empathetic partnership with clinicians and health literacy development. Considering these patient-led indicators of quality can support improvements in hemodialysis vascular access health service provision in New Zealand.