Table 3.

Representative Quotes: Social Worker and Nephrologist Responses to Open-Ended Survey Questions

	Sample Quotes from Surveys
What Worked Well
Intervention Characteristics	Put[s] the patient in control [of the discussion], not like rounds (SW) [Provided] an opportunity to talk with family and patient together (SW) Fostered trust between the patient and the team (SW)
Process	Having patient’s pre-survey ahead of time Intervention guideline (SW) E-mail reminders about what to cover (SW) Having privacy of an isolation room if ACP discussion took place while patient on dialysis (SW)
What Did Not Work Well
Intervention Characteristics	SW must be [physically] present at ACP discussion [not on phone] (SW)
Process	Families and patients needed more preparation for ACP discussion (SW) Doctor and social worker need to meet before ACP discussion to coordinate roles (SW) Too much time between recruitment and intervention (SW) Not good to have ACP discussion while patient on dialysis (SW)
Inner Setting	Hard to schedule time when all can be there (SW) Recording intervention session felt awkward (SW)
Outer Setting	Some patients not ready to discuss ACP (SW) Difficulty conducting discussion with patients with limited English proficiency (SW)
Personal Characteristics	None – the intervention is not necessary
Recommendations for Changes
Process	Start ACP either as soon as a patient begins or just prior to beginning hemodialysis Have more frequent follow-up discussions after initial discussion (SW) Meet patients at their homes for ACP discussions (MD) Conduct ACP discussions during rounds (MD) Have hospice worker or hospice handout at ACP discussion (SW) Train all dialysis staff to talk about ACP (MD) Make training inter-professional (SW)
Inner Setting	Make it a policy to hold ACP discussions annually (SW)
Outer Setting	Pay SW more for the additional work (MD)
Personal Characteristics	None – the intervention is not necessary (SW)

SW Social Worker, MD Nephrologist