Table 4.

Illustrative Quotes for Directional Response Categories (Positive, Mixed, Negative)

Directional Response	Scenario	Quote	Patient or Physician
Positive Response	Research Scenario	I would be willing to, really excited kind of, that they’re actually doing a study.	Patient
		I think definitely I would want to include [my patients] because I feel it theoretically makes sense that longer dialysis may be beneficial for slower fluid removal. I would like to know what subset of patients that did make sense for, if it made sense for anyone, and was actually clinically beneficial. I think enrolling patients in this study would help.	Physician
Mixed Response	Research Scenario	When I think about the length of the dialysis I mean there are pluses and there are minuses. The pluses is to live longer and feel better and the minus is the excessive amount of time.	Patient
		That would be the only thing that I would be hesitant if there was not a provision to decrease dialysis then maybe I would be hesitant. But honestly I still think I would do it.	Physician
Negative Response	Research Scenario	No, because like I said, being in this study they don’t really know. I’m not going to say you’re going to be a guinea pig but (laughs) that’s almost like being a guinea pig.	Patient
		You can’t say you’re participating in a study and all of you are now going to go to 4 ½ hours. Believe me, the first thing they would do was say I what? No, no, no, no. I’m going to another unit, sorry. You’d have a mass defection.	Physician
Positive Response	Clinical Scenario	I think it would really be benefitting me. Number one, when I first got on it was 4 ½ hours and I didn’t question why. But then I began to do some research myself. So in doing the research it has enhanced my longevity because of when you are getting this pulled off you your heart is in better condition.	Patient
		I think that that’s ultimately much more beneficial. The longer and slower you can remove the fluid I think is generally more beneficial for cardiac stunning. So I think that it’s a very good concept and I would like to try to do that with patients.	Physician
Mixed Response	Clinical Scenario	It may be able to process more waste, maybe take more fluid off, get your numbers a little bit more balanced. Those would probably be the biggest things that I could see. I know they can adjust this machine so you’re already going to be set for a certain amount of waste, certain amount of fluid. So I don’t know would the 4 ½ hours be beneficial? It would just be more time on this machine, away from your family. So I wouldn’t, I don’t know about that part.	Patient
		I don’t think there is data to support it so the fact that this is just a new practice rather than a clinical trial it’s kind of difficult to stomach that because you don’t necessarily know if what you’re doing really is of benefit or not.	Physician
Negative Response	Clinical Scenario	I don’t like the fact that they just sort of foist this upon you.	Patient
		I wouldn’t be very happy about it especially if it’s coming from the clinic itself not from the doctors. I would want to know why. That would raise my suspicions. Are they looking for a couple extra bucks?	Patient
		I feel like our clinical judgment would be compromised with using this protocol.	Physician
		You just cannot show up at the dialysis unit and he is being told by the dialysis nurses and the dialysis staff that this is what should be a good practice. So it should all start with the physician. So the physician will decide if it’s going to be 4 ½ hours or not.	Physician