2026-10-12T01:05:34Z https://api.figshare.com/v2/oai

oai:figshare.com:article/33297480 2026-09-24T11:40:28Z category_7 portal_147 item_type_3 month_year_09_2026

Supplemental Material for: Barriers to Person-Centered CKD Care: A Qualitative Study of Multidisciplinary Nephrology Clinicians figshare admin karger (2628495) In-Gu Kang (6432524) JoAnn S. Oliver (24607225) Nayoung Kim (67514) Ashley Abawi (24607226) Audrey Boahemaa Kusi (24607227) Felecia G. Wood (24607228) Pamela P. Foster (20474449) Sharlene D. Newman (5422763) Medicine Medicine <p dir="ltr">Introduction</p><p dir="ltr">The clinician-identified barriers to person-centered chronic kidney disease (CKD) care remain poorly characterized among socioeconomically disadvantaged populations. We examined nephrology clinicians’ perspectives on patient preparation, dialysis decision-making, and structural barriers to inform multilevel intervention.</p><p dir="ltr">Methods</p><p dir="ltr">A qualitative descriptive study using semi-structured interviews and thematic analysis following Braun and Clarke’s (2006) approach [29] included 22 English-speaking nephrology clinicians recruited via snowball sampling. Transcripts were analyzed thematically.</p><p dir="ltr">Results</p><p dir="ltr">Three themes emerged. First, CKD awareness, education, and preparedness: patient awareness was uneven and often absent even under nephrology care; education was multidisciplinary and stage-sensitive but emotionally constrained. Second, dialysis decision-making: planned outpatient initiation was distinguished from unplanned emergency starts, the latter associated with reduced patient choice and worse outcomes; modality discussions typically began at an estimated glomerular filtration rate (eGFR) of approximately 20 mL/min/1.73m² but timing varied widely; nephrology clinicians sometimes omitted home dialysis options when patient support seemed uncertain; and family involvement was central to adherence and decision quality. Third, barriers, supports, and clinical management: nonadherence reflected structural barriers, financial hardship, health literacy, transportation, and delayed referral, rather than motivation, while the clinician-patient relationship was a modifiable adherence determinant limited by understaffed support services.</p><p dir="ltr">Discussion</p><p dir="ltr">Nephrology clinicians identified patient awareness, education timing, provider variability, and structural barriers as modifiable determinants of inequitable CKD outcomes. Multilevel intervention targeting pre-dialysis education, primary care coordination, reimbursement reform, and social support infrastructure is needed.</p> 2026-09-24T11:40:28Z Dataset Dataset 10.6084/m9.figshare.33297480.v2 https://figshare.com/articles/dataset/Supplemental_Material_for_Barriers_to_Person-Centered_CKD_Care_A_Qualitative_Study_of_Multidisciplinary_Nephrology_Clinicians/33297480 CC BY 4.0