The Ottawa Hospital, Riverside Campus, 1967 Riverside Drive, Ottawa ON, K1BH 7W9, Canada.
BMC Nephrol. 2011 Feb 3;12:7. doi: 10.1186/1471-2369-12-7.
In patients with Stage 5 Chronic Kidney Disease who require renal replacement therapy a major decision concerns modality choice. However, many patients defer the decision about modality choice or they have an urgent or emergent need of RRT, which results in them starting hemodialysis with a Central Venous Catheter. Thereafter, efforts to help patients make more timely decisions about access choices utilizing education and resource allocation strategies met with limited success resulting in a high prevalent CVC use in Canada. Providing decision support tailored to meet patients' decision making needs may improve this situation. The Registered Nurses Association of Ontario has developed a clinical practice guideline to guide decision support for adults living with Chronic Kidney Disease (Decision Support for Adults with Chronic Kidney Disease.) The purpose of this study is to determine the impact of implementing selected recommendations this guideline on priority provincial targets for hemodialysis access in patients with Stage 5 CKD who currently use Central Venous Catheters for vascular access.
METHODS/DESIGN: A non-experimental intervention study with repeated measures will be conducted at St. Michaels Hospital in Toronto, Canada. Decisional conflict about dialysis access choice will be measured using the validated SURE tool, an instrument used to identify decisional conflict. Thereafter a tailored decision support intervention will be implemented. Decisional conflict will be re-measured and compared with baseline scores. Patients and staff will be interviewed to gain an understanding of how useful this intervention was for them and whether it would be feasible to implement more widely. Quantitative data will be analyzed using descriptive and inferential statistics. Statistical significance of difference between means over time for aggregated SURE scores (pre/post) will be assessed using a paired t-test. Qualitative analysis with content coding and identification of themes will be conducted for the focus group and patient interview data.
Coupling the SURE tool with a decision support system structured so that a positive test result triggers providers to help patients through the decision-making process and/or refer patients to appropriate resources could benefit patients and ensure they have the opportunity to make informed HD access choices.
对于需要肾脏替代治疗的 5 期慢性肾脏病患者，一个主要的决策涉及治疗方式的选择。然而，许多患者推迟了治疗方式选择的决策，或者他们有紧急或紧急的肾脏替代治疗需求，这导致他们开始使用中心静脉导管进行血液透析。此后，通过教育和资源分配策略来帮助患者更及时地做出关于通路选择的决策的努力收效甚微，导致加拿大中心静脉导管的使用非常普遍。提供针对患者决策需求的决策支持可能会改善这种情况。安大略省注册护士协会已经制定了一项临床实践指南，以指导成年人慢性肾脏病（成人慢性肾脏病决策支持）的决策支持。本研究的目的是确定实施该指南中选定建议对目前使用中心静脉导管进行血管通路的 5 期 CKD 患者的省级重点目标（即血液透析通路）的影响。
方法/设计：将在加拿大多伦多的圣米迦勒医院进行一项非实验性干预研究，采用重复测量方法。透析通路选择的决策冲突将使用经过验证的 SURE 工具进行测量，该工具用于确定决策冲突。然后将实施定制的决策支持干预措施。将重新测量并比较决策冲突，与基线分数进行比较。将对患者和工作人员进行访谈，以了解他们对这种干预措施的看法以及在更广泛的范围内实施的可行性。将使用描述性和推断性统计分析来分析定量数据。将使用配对 t 检验评估 SURE 评分（前后）的时间聚合分数之间差异的统计学意义。将对焦点小组和患者访谈数据进行定性分析，进行内容编码和主题识别。
将 SURE 工具与决策支持系统相结合，使阳性测试结果触发提供者帮助患者完成决策过程和/或将患者转介给适当的资源，这可能使患者受益，并确保他们有机会做出明智的 HD 通路选择。
