Box 1.
Theme 1: Competing priorities
| Quote* | Quotation [source] | Participant |
|---|---|---|
| 1a | I have to manage diabetes, high blood pressure, high cholesterol and being old, balance, falling, fear of falling. I mean, there are so many things going on. [patient interview] | 13 |
| 1b | How the hell is a person supposed to live a life when they are living on the streets or living with drugs and stuff in their lives? [patient interview] | 8 |
| 1c | It’s everything…If I just had the kidney problem, I could cope with that, you know, easily…But it’s everything together. That’s the problem. The kidney disease is just another worry. [patient interview] | 15 |
| 1d | Her kidney disease was not very far along. Her cancer needed better follow up, so I remember spending initial time with her trying to arrange better follow up with urology and imaging…we didn’t talk early in our relationship necessarily about dialysis and things like that. [clinician interview] | 7 |
| 1e | She stated interest in dialysis, she just doesn’t want to work on that right now, and I haven’t pushed it…Depression and dissatisfaction in her living situation and family relationships. So that really predominates with her. [clinician interview] | 29 |
| 1f | So now my kidney function is down to, I think, [my creatinine is] 2.5…Their biggest concern is they take me off my diuretic…but what happens is my legs swell up…I can’t move them…Take me off my diuretics, it hurts too much to walk…In my mind, I’d rather at least have some kind of quality of life than just sitting around doing nothing. [patient interview] | 33 |
| 1g | Right now, I’m dealing with a foot problem…I can only do one thing at a time. Let’s hope I get through that. [patient interview] | 39 |
| 1h | When I slowly discovered that maybe it wasn’t going to happen that fast, I somewhat lost interest in all of that. It didn’t seem like something that I needed to pay attention to and so I focused more on simply trying to maintain the level of function with what I’ve been doing. [patient interview] | 9 |
| 1i | For someone like the patient whose blood pressure, diabetes were out of control, they’re going to progress pretty fast. That’s why I really tried to push for getting her to [dialysis class] and learn about dialysis. [clinician interview] | 1 |
| 1j | She has a second issue which is she has a pararenal abdominal aortic aneurysm…We’ve concluded that the risks of attempted repair probably outweigh the benefit…Any attempt to treat her aneurysm is likely to make her kidney disease progress…In general, being on dialysis leads to a significant decrease in quality of life. [clinician interview] | 40 |
| 1k | The surgeons have told her that they don’t think she’s a good surgical candidate partially because of her kidney disease…One of the doctors set her up to see one of his colleagues at the university…And she did see another one of the providers here who is considering her for a less invasive repair…But nobody was really following through with that…[the patient] was not getting answers that she wanted, she felt she should get surgery. [clinician interview] | 28 |
| 1l | She would need a chest/abdomen/pelvis computed tomography with angiogram in order to make a final determination. The patient is approaching the need for hemodialysis…I discussed with her that the intravenous contrast might precipitate hemodialysis…She is leaning toward imaging. [medical record] | RR |
*
the number indicates the theme to which the quotation pertains; the letter indicates the order in which the quotation is referenced in the manuscript text