#6656 Patients' Perspectives on Haemodialysis Access: A Quantitative Study

Abstract

Background and Aims Vascular access is an essential requirement for haemodialysis (HD). There is strong evidence that an arteriovenous fistula (AVF) is preferable to access via a central venous catheter (CVC) for long term haemodialysis, yet many patients opt for access via a CVC. We performed a cross-sectional study to assess patient preferences regarding vascular access. The quantitative component of this work is presented here. Method Questionnaires were administered to patients attending dialysis at four sites in the East Anglia region of the UK (n = 380). Additional patient data was collected from medical records. Analysis was performed using the R software. Results 63% (n = 238) of patients completed the survey. The median age of respondents was 75 years (range 24-95 years), 64% were male (n = 153), the median length of time on dialysis was 23 months, and 64% (n = 152) were using an AVF. There was no significant association between age and form of access (p = 0.11). 65% of respondents believed that an AVF was the best access route for health, 10% believed a CVC was the best route, and 25% were unsure. This was not significantly affected by the participant's access route at the time of the study (p = 0.91) or self-reported pre-dialysis education (p = 0.09). Respondents who believed that the health professionals caring for them preferred AVFs were significantly more likely to believe that AVFs were best for their health (p < 0.0001 for both medical and nursing staff preference). However, overall, there was uncertainty about the preferred haemodialysis access of health professionals, with 40% and 47% of respondents unsure regarding the preference of medical and nursing staff, respectively. These patients were also more likely to respond as ‘unsure’ as to which access type was better for their health. We asked participants to rate 16 possible concerns they may have about access on a 1-9 scale (Figure 1). The most highly rated concerns were related to sleeping, pain, bleeding and access longevity, each receiving a rating of ≥2 in nearly 40% of participants. Notably, infection risk was rated as the lowest priority concern, only receiving a rating of ≥2 in 5% of participants. Concerns were similar regardless of the active form of access. 63% (n = 54) of respondents with a CVC would not consider changing to an AVF. The decision to switch from CVC to AVF was not significantly associated with age (p = 0.69), or the number of AVF operations a patient had undergone in the six years prior to the study year (p = 0.94). The decision was also not associated with respondent belief regarding the best access type for health (p = 0.84). Differences in access concerns could not significantly explain the decision to or not to switch from CVC to AVF. However, analysis of free-text responses identified peer experiences as a strong influence on the decision to switch. Conclusion Most HD patients are aware that an AVF is associated with better health outcomes than a CVC. Despite this, a large proportion of patients dialysing via a CVC do not wish to change their access, with many reporting concerns of bleeding, needling pain, and difficulty sleeping. Infection risk was not a consideration for most patients. Additionally, we found that patients reported significant uncertainty about doctor and nurse preference for haemodialysis access. These findings are mirrored by analysis of the free text responses to the questions in this study. In particular, peer experiences were a significant determinant of the decision to switch from a CVC to AVF. The findings suggest that when we discuss vascular access with patients, a broad scope of topics should be addressed, beyond health outcomes alone, to allow for effective shared decision making. They also suggest that there is room to improve the communication of our perspectives as healthcare workers, both from a nursing and medical perspective.