Table 3.

Representative Quotes From Family Members

Theme 1: Conservative management not viewed as a viable personal option	Interviewer: “And if the person is feeling bad and he still doesn’t want to receive dialysis, what do you think about that?” Respondent: “I would need to consult my children and we would do what they said. I am the first one, but my children… if he really needed it… at that point we would have to decide… I would have to decide. I have already spoken to my children, and he would accept it. But, now we see he is fine… I can’t force him to have it unless his doctor told him he needed it.” Interviewer: “And what if he says he doesn’t want to have it?” Respondent: “If his doctor told him he should have it, then I would tell him to do so.” Interviewer: “But what if he doesn’t want to receive it?” Respondent: “If he doesn’t want it, there is nothing we can do about it.” Interviewer: “How would you feel if the doctor recommended it and he doesn’t want to have it?” Respondent: “Bad because if his doctor is telling him, it is clear that he needs it, so I would consult with my children and he would have to receive it. If it’s a direct order from the doctor, then I would force him to have it. If his doctor told me, ‘Look, your husband needs it now’ [then I would say] ‘It’s the doctor’s order, not mine, and you need it!’”
Theme 2: Understanding the realities of dialysis only abstractly	Interviewer: “What do you think would help both of you in terms of deciding what choice X actually ends up with?? Respondent: “I think if she’s not doing so bad, I don’t want her to suffer.” Interviewer: “How do you think she would suffer, by going through dialysis or by not having dialysis?” Respondent: “She’s not going to suffer from dialysis. It might help her and it might not because you can’t be too sure that dialysis won’t help you. That’s the way I feel about it now. If it can help you, let it help. If it’s no good for her, she doesn’t need it. She might be too old for it. I don’t know. I don’t know. I would know what I would say to myself when I get too old for stuff, I wouldn’t want it.”
Theme 3: Considering dialysis the only treatment option for kidney failure	Interviewer: “What do you think about people who choose not to go on dialysis?” Respondent: “I think they’re crazy.” Interviewer: “Why?” Respondent: “Because that’s for you. You have to go because your kidneys are failing.”