Table 4.
Themes and sub-themes from patient and staff interviews
| PATIENTS | |
| ● The emotional burden of ESRD and treatment | |
| ○ Life-saving but not curative treatment | |
| ○ Emotional toll of treatment and impact on lifestyle | |
| ○ Bottling up emotions | |
| ● Patients have complex, multi-faceted support needs | |
| ○ (Presence or absence of) self-support and personal coping mechanisms | |
| ○ Staff recognition of distress | |
| ○ Experience of support provided by renal unit | |
| ○ Experience of support provided by renal staff | |
| ○ Family support | |
| ○ Renal unit atmosphere and environment and impact on disclosing distress | |
| RENAL STAFF | |
| ● Patients and distress | |
| ○ Identifying distress is challenging (detecting distress; patient reluctance to disclose distress) | |
| ○ Beliefs about distress in ESRD patients (distress at times of change; are some patients more prone to distress?) | |
| ○ Responding to distress is difficult (different approach from clinical care; meeting the needs of BME patients) | |
| ● Staff roles and skills | |
| ○ Role perceptions (it’s everyone’s role; it’s not my role but whose is it?) | |
| ○ Fears (fears related to talking about distress; the emotional load of talking with distressed patients) | |
| ○ Skills, confidence and training (skills; training about supportive services; scepticism over the benefits of training) | |
| ● Care organisation | |
| ○ Limited capacity to respond (perception about how much time is needed; care settings and facilities limit responsiveness; variable access to specialist services) | |
| ○ Differences between staff groups (doctors, nurses and other renal staff; staff groupings) | |
| ● Changes | |
| ○ What helps (staff-patient relationships; more listening, less talking; normalising distress) | |
| ○ What needs to change (access to immediate support; structured approach to identifying distress; reducing the stigma of distress) |