Abstract
Clinical Practice Guidelines for haemodialysis vascular access recommend shared decision-making. Patient decision aids are evidence-based interactive tools designed to structure the shared decision-making process, and have high quality evidence for improved patient knowledge, healthcare participation, and decisional satisfaction. Setting specific vascular access resources are prioritised by patients. We developed a decision aid for planning vascular access for patients new to haemodialysis in Aotearoa New Zealand.
Decision aid development was informed by The International Patient Decision Aids Standards (IPDAS) development process in conjunction with local guidelines for health literacy resources (Rauemi Atawhai). A multidisciplinary steering group, including Indigenous and patient partnership, identified the needs of decision aid users (patients, caregivers, and clinicians) from existing literature. The prototype decision aid structure was based on the Hui Process, an Indigenous Māori model for meetings, and incorporated the Three Step Model for meeting adult health literacy needs. Content was derived from the Kidney Disease Outcomes Quality Initiative vascular access guidelines and published reports of patient priority outcomes. Three iterative cycles of co-creation involving patients and clinicians informed the final resource.
The decision aid, “Planning Together”, consists of a booklet to be shared with patients and families, and a short form resource to guide clinicians. “Planning Together” provides a structured guide for clinical conversations, enabling relationship building for patients and clinicians involved in decision making, connecting and understanding shared priorities, developing health literacy related to dialysis vascular access, identifying patient preferences, and completing a flexible “Access Plan”.
The resource characteristics of increasing health literacy and patient participation was highly valued by users. This resource will be formally evaluated then made available for use and adaptation.