Table 2.

Providers’ perceived challenges to patients’ preparation for renal replacement therapy

Themes	Subthemes	Type of providers identifying
System-level challenges
Limited time for optimal patient preparation	• Limited time to prepare	Nephrology
	• Limited time to build trusting relationships	Nephrology
Referral process delays	• Delays in referral to vascular surgery	Nephrology
Poor primary care/nephrology co-management	• Poor information exchange	Nephrology and Primary care
	• Lack of patient CKD education prior to nephrology referral	Nephrology
	• Poor delineation of roles	Primary care
Provider-level challenges
Provider difficulty with explaining CKD and confirming patient understanding	• Conveying CKD in lay terms	Nephrology
	• Uncertainty about patient understanding of RRT options	Nephrology
Patient-level challenges
Patients’ poor acceptance and understanding of CKD	• Denial of CKD diagnosis and/or severity	Nephrology
	• Poor understanding of CKD	Nephrology
	• Low awareness/understanding of treatment options	Nephrology
Patients’ low perceived urgency for RRT preparation	• Delayed preparation because asymptomatic	Nephrology
	• Poor compliance with RRT preparation appointments	Nephrology
Patients’ negative perceptions about RRT	• Fear/anxiety about dialysis	Nephrology
Patient cultural or language differences	• Patient preference for alternative treatments	Nephrology
	• Poor patient understanding due to cultural and/or language differences	Nephrology
Lack of patient trust	• Low patient trust in health providers	Nephrology