title: Primary care physicians' perceived barriers and facilitators to conservative care for older adults with chronic kidney disease: design of a mixed methods study.
abstract: BACKGROUND
  Guideline committees have identified the need for research to inform the provision of conservative care for older adults with stage 5 chronic kidney disease (CKD) who have a high burden of comorbidity or functional impairment. We will use both qualitative and quantitative methodologies to provide a comprehensive understanding of barriers and facilitators to care for these patients in primary care.
  
  
  OBJECTIVE
  Our objectives are to (1) interview primary care physicians to determine their perspectives of conservative care for older adults with stage 5 CKD and (2) survey primary care physicians to determine the prevalence of key barriers and facilitators to provision of conservative care for older adults with stage 5 CKD.
  
  
  METHODS
  A sequential exploratory mixed methods design was adopted for this study. The first phase of the study will involve fundamental qualitative description and the second phase will be a cross-sectional population-based survey.
  
  
  METHODS
  The research is conducted in Alberta, Canada.
  
  
  METHODS
  The participants are primary care physicians with experience in providing care for older adults with stage 5 CKD not planning on initiating dialysis.
  
  
  METHODS
  The first objective will be achieved by undertaking interviews with primary care physicians from southern Alberta. Participants will be selected purposively to include physicians with a range of characteristics (e.g., age, gender, and location of clinical practice). Interviews will be recorded, transcribed verbatim, and analyzed using conventional content analysis to generate themes. The second objective will be achieved by undertaking a population-based survey of primary care physicians in Alberta. The questionnaire will be developed based on the findings from the qualitative interviews and pilot tested for face and content validity. Physicians will be provided multiple options to complete the questionnaire including mail, fax, and online methods. Descriptive statistics and associations between demographic factors and barriers and facilitators to care will be analyzed using regression models.
  
  
  CONCLUSIONS
  A potential limitation of this mixed methods study is its cross-sectional nature.
  
  
  CONCLUSIONS
  This work will inform development of clinical resources and tools for care of older adults with stage 5 CKD, to address barriers and enable facilitators to community-based conservative care.
authors.affiliation: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada.
authors.forename: Helen
authors.initials: H
authors.lastname: Tam-Tham
authors.affiliation: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada.
authors.forename: Brenda
authors.initials: B
authors.lastname: Hemmelgarn
authors.affiliation: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada ; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada.
authors.forename: David
authors.initials: D
authors.lastname: Campbell
authors.affiliation: Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada.
authors.forename: Chandra
authors.initials: C
authors.lastname: Thomas
authors.affiliation: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada ; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Quinn
authors.affiliation: Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Fruetel
authors.affiliation: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada ; Faculty of Nursing, University of Calgary, Professional Faculties, Room 2209, 2500 University Drive NW, Calgary, Alberta T2N 1N4 Canada.
authors.forename: Kathryn
authors.initials: K
authors.lastname: King-Shier
keywords: Chronic kidney disease; Conservative care; Mixed methods; Non-dialysis care; Older adults; Primary care physicians