Patient perspectives on quality healthcare for hemodialysis vascular access

This is the authors' abstract. We don't add key points for this paper.

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. Learning points Patient priorities for haemodialysis vascular access healthcare include: Clinical processes which demonstrate integration between services, deliver timely clinical assessment and intervention, opportinities to discuss individual access management, expert nursing care and psychological support. Support for increasing healthcare literacy such as informational resources, clinician support for learning, peer-to-peer learning, clear explainations of procedural details and expected results, and enabling preparedness for vascular access care. Empathetic communication, which demonstrates clinician understanding of patient experiences, clinician responsiveness to self advocacy and patient inclusion in decision-making. Trusting partnerships with healthcare providers were highly prioritised