Table 5.

Circumstances Under Which Challenges Are Encountered by Patients

Theme	Category	Code	Quotations
I do not have a bond with my health care professional	I do not see or speak to my HCP very often	The doctor does not have much time	“Then I got a bit of a speedy Gonzales, it was all a bit too quick for me. He did everything so quickly. I did trust him, but you just didn't really have any contact.” Female, aged 72, married, COPD and CHF
		I only see the doctor/nurse once or twice a year	“My first hospital admittance was this year while I've been seeing him for five years now. In those five years, you see him twice a year at the most, so you don't really develop a bond.” Female, aged 72, married, COPD and CHF
		The GP is not in the picture	“The internist is my main practitioner. I have little contact with my GP.” Female, aged 74, widow, CHF
		I keep getting different doctors (GP/cardiologist)	“We've had so many changes in recent years. Also with cardiologists, you never really have a bond with them, with those people. They leave too quickly.” Female, aged 88, married, CHF
	I do not feel any connection with my health care professional	I do not experience a ‘click’	“To be honest, I didn't really like her [heart failure nurse] that much. And then you are less inclined to say much.” Female, aged 82, widow, COPD and CHF
		I think that the HCP acts detached	“We could talk easily with the first cardiologist. About symptoms or anything else. But when they are so stand-offish. And that's the case now.” Female, aged 88, married, CHF
	I do not feel like an equal to my health care professional	I get the feeling that my HCP is above me	“Because this GP shows empathy. The previous GP tended to look down on you. They would briefly tell you what you had to do.” Male, aged 80, living together, COPD and CHF
		I get the impression that the HCP does not regard me as an equal	“They [two nurses] had a whole story about all that needed to be done. And, you know what? And he [her husband] says: “I can still see your face; completely speechless you were.” As if I was some kind of stupid old person. I really felt that strongly then, that I was being treated as inferior. Female, aged 88, married, CHF
I cannot have a good conversation with my health professional	I cannot make good contact with my health professional	We do not make eye contact	“They need to listen to me properly and what really irritates me is that they have a screen in front of them. If I only have 10 minutes and they sit looking at their screen for almost 10 minutes, then I don't feel like I'm being taken seriously. I want us to look at one another and talk to each other. That he can also see me, because when you look at someone you make contact.” Female, aged 72, married, COPD and CHF
		The conversation is completely one-sided	“He [GP] lets people talk a bit when you are there. Then he sits and looks at you for a bit.” Female, aged 88, married, CHF
	I do not feel any depth to our conversations	Our contact is superficial	Interviewer: “Which health professional do you know the best?” Respondent: “No idea. It's all so superficial.” Female, aged 82, widow, COPD and CHF
		We only talk about physical/medical matters	“We always discuss health and what can be done about it. Always the medical aspects.” Female, aged 82, widow, COPD and CHF
	I do not give or ask for information myself	It does not seem useful to me to share certain information with my health professional	“Ooh, but we don't even talk about that either [physical deterioration]. No, they [healthcare professionals] can't do anything about that anyway.” Female, aged 72, married, COPD
		I do not feel important enough to ask for attention for myself	“Ach, even if I do say what I think, I'm a nobody who's going to become nothing, so just forget it.” Female, aged 82, widow, COPD and CHF
		I do not know what I can say and/or ask	“Well yes, I never really have anything to discuss. Only if I feel something or whatever. And when it's going well, what do I say then, I'm fine thanks?” Female, aged 76, married, CHF