Box 2.

Theme 2: Focusing on present or future

Quote	Quotation [source]	Participant
2a	There’s no cure for kidney disease. You just live until you get real sick and then you get into dialysis. If not, you just got to die. That’s all. [patient interview]	12
2b	I don’t have any feelings about death at this point. I’m not even thinking about it. I’m just thinking about every day and waking up and having a good day. I don’t really bother to think way into the future…My parents, gave me the idea that you accept your situation and not dwell on the negative. [patient interview]	26
2c	It’s hard to explain. I actually tell my body to heal itself. It’s one of the things I was taught: positive thinking. If you have a negative attitude, if you start saying, “I’m dying” or “my kidneys are failing,” they will! [patient interview]	37
2d	“You’ve got to have a caregiver, now!”…I just busted my butt trying to find her…“You’ve got to change this diet!“…The diet has been hell…They wanted me to find someone to donate a kidney…“Find yourself a kidney!”….[My doctors] never let up…I was supposed to rush forward and show them I could do everything they wanted. But they were just thinking about it, my life was trickling by, my time here on earth is going away, and if I don’t get a kidney or if I need one. [patient interview]	5
2e	Just every day, take one day at a time. I’m glad to be here. Tomorrow is not promised. [patient interview]	17
2f	She is beginning to see the value of slowing down and trying to pay more attention to what is happening now, not so much focused on the future where she feels more limited. [medical record]	R
2g	Her renal function continues to decline. At such a rate, she would likely progress to end-stage renal disease in the next 12 months. Patient states she was told she needs dialysis many years ago, but “nothing ever happens…” I discussed the need to prepare for vascular access early…Despite extensive counseling, patient declines referral to vascular surgery. [medical record]	O
2h	I struggled a lot about how to say this, you know, that “when your kidneys are no longer working, you can’t live…” our conversations over the last six months have been quite serious and I leave the visit feeling, you know, “have I done enough? Have I explained it clearly enough?“ [clinician interview]	6
2i	I’m very mindful of how fear modifies their response. I’ve never met a patient when, if I tell them, “You need dialysis,” says, “Hey, start me on dialysis.” Never met a patient. Even if a patient may not articulate fear, they’re afraid. [clinician interview]	22