Table 2.

An overview of the findings and chosen quotations*

Category headings†	The decision was experienced as being their own (28 participants and 66 quotes). “At the first meeting, my son and daughter-in-law were with me. And when we drove home, we did not talk much about it. I let a few days pass and I thought, ‘Let them just go and… They should also have time to think a little, and I should have some time to think what I was going to say at the next meeting and all…’ Then I talked to them. Then I asked, ‘What would you choose after the first meeting?’ They would choose dialysis at the hospital. Then I said, ‘Well, it’s funny that you say that because that’s what I’ve decided, that’s how I want it to be’. I‘ve decided this myself, and I think it’s a good thing that it’s not just the hospital saying what I’m going to do. I hope, because I have decided this myself, I must make the best of it when it can’t be any different. Rather than saying that we have just decided this over your head and then say, ‘Oh, it’s so annoying that they make the decisions’. There is no one to blame if I think it’s a bad decision. Only myself anyway. It is already hard enough. It’s my own decision. I actually think it’s quite important that you make the decision yourself. I’m old enough to do that. I have not been good at saying no before, but… It’s my life and it’s my choice and that’s how it should be.” (patient 16)‡
Codes§	Other decisions (14 participants and 28 quotes). “Well, that’s probably the first time I’ve participated in a decision about my illness and treatment. I had an operation on my throat, and I was just told how it should be and when it should be. So I just had to show up. So far, I have just been to see my doctor to get to know how my illness was developing. I get medicine, but I have not been a part of that decision. I have no background to know anything about it, but [in this situation] I have done so. Well, I don’t know. I would not have been surprised if you had just decided what to do, because the doctors usually decide everything. And I wouldn’t know I had other options.” (patient 8)
Category headings†	The meetings contributed to the decision process (29 participants and 95 quotes). “If I should have done it [made a decision] without the meeting, it would have been hard. Because then I would have to read about it and I would really not understand a thing. I would not be able to see myself [which decision was right for me]. Now, the dialysis coordinator like explained the different scenarios to me. And it’s in light of this I said that I want peritoneal dialysis. She [the dialysis coordinator] supported this – ‘I think this is right for you’, she said. So no, no, it’s my own decision – 100%.” (patient 10)
Codes§	Questions to and from the patient (21 participants and 39 quotes). “She [the dialysis coordinator] actually puts the questions she has to ask in a nice way. Not like a chainsaw. In a nice way. And I also think she manages to get some answers from people when she does it like that. I‘m not an open person, I keep things to myself, and people have to lure things out of me. Her questions make me think about things. It gives me peace of mind to get rid of what I‘m thinking about. I want to know what it is, and it must be reliable, what I‘m told. And I always think I‘ve received an answer. Because… that’s life. Life has taught me that if I do not ask, I don’t get any answers. Here, she asked her questions, because it was unfamiliar territory. I’m on shaky ground. I had the question, ‘Why is it haemodialysis you want, and why is it not peritoneal dialysis?’ Then we talked about the differences. Well, what happens in my everyday life if I choose haemodialysis and what happens if I choose peritoneal dialysis? And I know that with peritoneal dialysis, I can have some equipment I can take around with me.” (patient 13)
	Accurate information was helpful for the patient (12 participants and 20 quotes). “It was positive to have the meetings with XX [a dialysis coordinator]. Because she told me a lot. And she had an answer ready when I asked. And I’m sorry to say, but some of them [other healthcare professionals], I call them circus clowns. They say ‘Ah, well…’ and ‘I have to look into that’ and ‘I will be back with an answer’ and stuff like that. But XX [a dialysis coordinator], she did not act in that way. I asked and then she had the answers right at hand.” (patient 12)
	Bringing a relative into the meetings contributed to the decision process (24 participants and 75 quotes). “Well, it has meant a lot to me that my wife was with me at the meetings because we were able to talk about it afterwards. She is my extra pair of ears. I have some problems with hearing. It is nice to have somebody there with you, because you get emotional sometimes. So she’s not just there because of my bad hearing. The information at the meetings gets me started thinking, I get emotional, and then I don’t listen that well. We are in such a vacuum at the moment, waiting to get started with a new part of our life. It is primarily me, but of course also her. It affects everybody in our household.” (patient 13)
Category headings†	The decision aid contributed to the decision process (29 participants and 70 quotes). “But when you sit there starry-eyed and don’t know anything, it [the decision aid] can help a lot. Also that you get more information about it [the decision].” (patient 1)
Codes§	The overview of options contributed to the decision process (18 participants and 28 quotes). “The further we went down the list of options, the more it became clear to me that I want P-dialysis. That’s what I want. That’s the solution that suits my life and my need for freedom best. I think the different colours will do something for me. I heard what she told me, read the chart, saw the different colours when she pointed at them, it meant something to me.” (patient 3)
	The value clarification tool contributed to the decision process (15 participants and 25 quotes). “We were in a state of rebellion. We were a bit confused. Because we were not really aware of what was happening or should happen or what could happen. But then we worked with it at home and talked about it. We had an assignment to do at home that we went through together. The assignment made us arrive at this decision. I think it made us compare the different options. It gave us an overview because we could compare pros and cons.” (patient 23)
	The videos contributed to the decision process for some patients (14 participants and 17 quotes). The best thing about it was the short video with the man who had lived with P-dialysis for 11 years, and it’s obvious that he would rather live with dialysis than not live at all. And that kind of helped. He apparently seemed to be doing well. He seemed happy and satisfied. It helped me a lot, because I sometimes worry. I’m a little afraid of dialysis. It’s a big deal to me and then… It was really good, because it made me less concerned about what it [dialysis] really would be, or it actually made my concern disappear.” (patient 19)
	Other patients contributed to the decision process sometimes (13 participants and 38 quotes). “I probably had some reservations from the start. Because I was hospitalised in April last year, and I was with a guy on peritoneal dialysis. He participated in biker meetings, and sometimes, he just had peritoneal dialysis and then he went out [biking] again. And if he could do it, so could I with my hobby as a dog trainer. I would also do it in that way. I got an impression of freedom he had. I didn’t think so much about going on dialysis myself. But I saw it as a good experience, and something that was good, and the treatment was good.” (patient 8)
Category headings†	The decision process was experienced as being iterative (28 participants and 140 quotes). “So we have had the number of meetings we think we needed. But we don’t know yet. The difficult thing here is that we are talking about something we imagine. It’s like a trip we’re going on. Then you have some expectations, but you don’t know where it really ends. It’s like when we start this, we’ll get to know something, and it’s great, what we are told, but we don’t know if there will be any questions along the way, and there automatically will be. Afterwards, we had the experience, we bought the trip or we have been on it. I have become more sure of it [my decision], after the meetings, that is. At the kidney school [a 2 day Kidney school, each day with a four hour information session on chronic kidney disease] they told me it should be peritoneal dialysis, or perhaps, but without deciding, but it was the decision I was more likely to make. And then after those meetings, I realised that it should be peritoneal dialysis. So, I made a decision, right.” (patient 5)
Codes§	Dialysis choice came as a shock (14 participants and 48 quotes). “You have had diabetes for about 15 years; you haven’t thought that it would mean that your kidneys failed at some point and that you have to have dialysis.” [Interviewer] “You thought then that you might lose a leg, but then I thought I haven’t smoked since 1981. But I haven’t thought about the kidneys. She told me that it’s now time for dialysis or transplantation. It was a shock, I admit – like out of the blue. I was pretty shaken. And now, you have seen what kind of options you have and what the next step is… I decided at the third meeting because it was new to me and it was kind of a shock. It felt like the rug being pulled from under my feet.” (patient 26)
	Received new information during the interview (11 participants and 35 quotes). “Really good. Well, I’m already much more informed.” (patient 17) “And I shouldn’t tell you anything today, I just want to listen. It’s you who should tell me something.” [Interviewer] “So, and then they say that, in the end, you can’t pee. Well, now, what is that about? So, I can’t imagine it, not being able to pee, and where and how does the pee accumulate? Do you at some point turn into a balloon?” (patient 27) “Your urine production will slow down gradually. But then the fluid is removed by dialysis. It’s the dialysis removing the urine because it draws out the fluid.” [Interviewer]
	Not sure it was the right decision (5 participants and 13 quotes). “I try not to think about it from day to day. But now and then, you think, ‘What is it that I’ll be going through?’ And then I think, ‘Tubes in the stomach, that was unusually uncomfortable. Could I get peritonitis?’ I think. But, of course, you can also get something with the other [dialysis modality], right? Yes, and I think many, many, many times about whether it was the right decision. Just think, you get this machine home with you and all those boxes, and they take up a lot of space. I don’t know how much, but they are delivered by a truck. That sounds terrible, doesn’t it? Do I have enough room? And how long is the tube that is going to reach the bathroom? And we have two cats who play around at night and have a wonderful time. They play with stuff. I think about how thirst will turn out. And it has to be totally clean, the room you sleep in [and use for dialysis].” (patient 27)
	Preferred not to receive dialysis (13 participants and 23 quotes). “Well, you have to understand that I don’t go around hoping for dialysis because, first of all, it doesn’t look very sexy and, secondly, it limits me. It limits the life I would like to live, but I’m also realistic, I know it’s coming. You should know that. Because I would have preferred to avoid it – who wouldn’t? No, it’s a choice between plague and cholera, there’s no doubt about that.” (patient 10)
	‘No dialysis’ was not an option (9 participants and 17 quotes). “So, I decided after all that dialysis had to be better than just doing nothing. But we have talked about the fact that we are old, we have experienced a lot, nobody owes us anything in this life – no good and bad things. So that was part of my considerations.” (patient 19)

*The quotations have been translated into English as accurately as possible.

†The category headings are underlined.

‡The numbers in brackets are the identification numbers of the participants.

§The codes are in italics.