Table 4.

Cognitive interview key findings and responsive material updates ^a

Element	Key findings	Responsive material updates
Patient materials
Content	Clear and succinct introduction needed	Created cover page with brief overview
	Phrase ‘working for you’ unclear	Replaced with ‘meeting your needs’
	Phrase ‘Don’t be afraid to speak up’ felt patronizing to some participants	Replaced with ‘Don’t be shy! Speak up! Your voice matters’.
	Term ‘person-centered’ difficult to understand	Replaced with ‘what matters most to you’
	Term ‘individualized’ unclear	Updated to ‘unique to your needs and priorities’
	Term ‘care plan’ rarely recognized without description or additional context	Added content on meeting frequency, attendees and discussion topic examples to orient patient to care plan meeting
Formatting	Text-heavy, increase white space	Converted paragraph text into bullet points
	Headers not easily noticeable	Bolded, colored and increased header font size
	Sequence of items unclear	Added numbering when applicable
General comments	Physically difficult to distinguish from other documents received in clinic	Altered material dimensions and paper weight and added more color to clearly differentiate
	Receiving a copy of the care plan may help patients remember the meeting discussion	Added, ‘Your care team will give you a copy of your care plan to take home’.
	Consistent communication is helpful, but patients often have different relationships with different care team members	Added, ‘You can always talk to a care team member. You don’t have to wait for another meeting’.
	Preparation questions helpful and relevant, but not comprehensive	Added questions about overall dialysis experience/ concerns and desired life changes
Care team materials
Content	Lacks instructions to orient reader	Created cover page with brief overview
	Seems bulky, difficult to skim easily	Added table of contents for easier navigation
	Redundant between sections	Collapsed information
	Example priorities, barriers, challenges and solutions need to be more realistic, less ideal	Used specific examples as recommended in various interviews
	Example solutions appear to be concrete answers, rather than suggested approaches	Edited to acknowledge variability in possible actions for individual patients and circumstances
Formatting	Text-heavy, but should retain information	Changed paragraph text into bullet format
	Conversation guide appears to be suggestions for engaging in discussion, rather than step-by-step instructions	Numbered steps to indicate a clear process by which to elicit patient preferences
General comments	Timeline seems unclear; care teams would likely need to alter from clinic to clinic	Updated language to reflect a more flexible timeline to meet individual clinic needs
	Lacking in disease-specific examples; contains too much emphasis on personal priorities	Added more examples of health-related patient priorities and possible actions
	Process requires effort, but would create meaningful patient interactions and more individualized care plans	Incorporated language around significance of helping patients achieve both their personal and medical goals
	Resources helpful for meeting preparation, patient engagement and team organization	Merged resources and process description into single care team packet

^a Data garnered from patient and care provider cognitive debriefing interviews.