title: Setting Priorities for Optimizing Vascular Access Decision Making--An International Survey of Patients and Clinicians.
abstract: BACKGROUND
  Many decisions around vascular access for haemodialysis warrant a collaborative treatment decision-making process, involving both clinician and patient. Yet, patients' experiences in this regard have been suboptimal. Although clinical practice guidelines could facilitate collaborative decision making, they often focus on the clinicians' side of the process, while failing to address the patients' perspective. The objective of this study was to explore and compare kidney patients' and clinicians' views on what vascular access-related decisions deserved priority for developing guidelines that will contribute to optimizing collaborative decision making.
  
  
  METHODS
  In the context of updating their vascular access guideline, European Renal Best Practice surveyed an international panel of 85 kidney patients, 687 nephrologists, 194 nurses, and 140 surgeons/radiologists. In an electronic questionnaire, respondents rated 42 vascular access-related topics on a 5-point Likert scale. Based on mean standardized ratings, we compared priority ratings between patients and each clinician group.
  
  
  RESULTS
  Selection of access type and site, as well as prevention of access infections received top priority across all respondent groups. Patients generally assigned higher priority to decisions regarding managing adverse effects of arteriovenous access and patient involvement in care, while clinicians more often prioritized decisions around sustaining patients' access options, technical aspects of access creation, and optimizing fistula maturation and patency.
  
  
  CONCLUSIONS
  Apart from identifying the most pressing knowledge gaps, our study provides pointers for developing guidelines that may improve healthcare professionals' understanding of when to involve patients along the vascular access pathway.
authors.affiliation: European Renal Best Practice (ERBP) Methods Support Team, University hospital Ghent, Ghent, Belgium; Health e-Research Centre, Institute of Population Health, University of Manchester, Manchester, United Kingdom.
authors.forename: Sabine N
authors.initials: SN
authors.lastname: van der Veer
authors.affiliation: European Renal Best Practice (ERBP) Methods Support Team, University hospital Ghent, Ghent, Belgium; Center for Medical Statistics, Informatics and Intelligent Systems (CeMSIIS), Section for Clinical Biometrics, Medical University Vienna, Vienna, Austria; Department for Internal Medicine III, Nephrology and Hypertension Diseases, Transplantation Medicine and Rheumatology, Krankenhaus Elisabethinen, Linz, Austria.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Haller
authors.affiliation: Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU university, Amsterdam, the Netherlands.
authors.forename: Carina A C M
authors.initials: CA
authors.lastname: Pittens
authors.affiliation: Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU university, Amsterdam, the Netherlands.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Broerse
authors.affiliation: Sussex Kidney Unit, Brighton & Sussex University Hospital, Brighton, United Kingdom.
authors.forename: Clare
authors.initials: C
authors.lastname: Castledine
authors.affiliation: Vascular Access Society (VAS), Maastricht, the Netherlands; Nephrology and Dialysis Unit, Ospedale San Carlo Borromeo, Milano, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gallieni
authors.affiliation: Vascular Access Society of Britain and Ireland (VASBI), Glasgow, United Kingdom; Department of Renal Transplantation and Renal Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Inston
authors.affiliation: Department of Nephrology, CHGU Valencia, Valencia, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Marti Monros
authors.affiliation: Health e-Research Centre, Institute of Population Health, University of Manchester, Manchester, United Kingdom.
authors.forename: Niels
authors.initials: N
authors.lastname: Peek
authors.affiliation: European Renal Best Practice (ERBP) Methods Support Team, University hospital Ghent, Ghent, Belgium; Renal division, University Hospital Ghent, Ghent, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: van Biesen
mesh_terms: D000328:Adult; D000368:Aged; D003657:Decision Making; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010361:Patients / Q000523:psychology*; D010820:Physicians / Q000523:psychology*; D011795:Surveys and Questionnaires