title: Patient perspectives on the optimal start of renal replacement therapy.
abstract: BACKGROUND
  Healthcare systems and providers are encouraged to prepare their patients with advanced chronic kidney disease (CKD) for a planned start to renal replacement therapies (RRT). Less well understood are the socioemotional experiences surrounding the optimal start of RRT versus suboptimal haemodialysis (HD) starts with a central catheter.
  
  
  OBJECTIVE
  To characterise the experiences of patients beginning RRT.
  
  
  METHODS
  Qualitative, semi-structured phone interviews.
  
  
  METHODS
  A total of 168 patients with stage 5 CKD initiating RRT in an integrated, capitated learning healthcare system.
  
  
  METHODS
  Qualitative data from patients were collected as part of a quality improvement initiative to better understand patient-reported themes concerning preparation for RRT, patients' perceptions of their transition to dialysis and why sub-optimal starts for RRT occur within our healthcare system. Dual review and verification was used to identify key phrases and themes within and across each domain, using both deductive a priori codes generated by the interview guide and grounded discovery of emergent themes.
  
  
  RESULTS
  From the patient perspective, preparing for RRT is an experience rooted in deep feelings of fear. In addition, a number of key factors contributed to patients' preparation (or failure to prepare) for RRT. While the education provided by our system was viewed as adequate overall, patients often felt that their emotional and psychosocial needs went unmet, regardless of whether or not, they experienced an optimal dialysis start.
  
  
  CONCLUSIONS
  Future efforts should incorporate additional strategies for helping patients with advanced CKD achieve emotional and psychological safety while preparing for RRT.
authors.affiliation: Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, California, USA.
authors.forename: Shayna L
authors.initials: SL
authors.lastname: Henry
authors.affiliation: Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, California, USA.
authors.forename: Corrine
authors.initials: C
authors.lastname: Munoz-Plaza
authors.affiliation: Harvard T. H. Chan School of Public Health, Cambridge, Massachusetts, USA.
authors.forename: Jazmine
authors.initials: J
authors.lastname: Garcia Delgadillo
authors.affiliation: Kaiser Permanente Southern California Baldwin Park Medical Center, Baldwin Park, California, USA.
authors.forename: Nichole K
authors.initials: NK
authors.lastname: Mihara
authors.affiliation: Kaiser Permanente Southern California Baldwin Park Medical Center, Baldwin Park, California, USA.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Rutkowski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000592:standards; D002983:Clinical Competence / Q000592:standards; D005239:Fear / Q000523:psychology; D005260:Female; D006282:Health Personnel / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010361:Patients / Q000523:psychology*; D010465:Perception; D036301:Qualitative Research; D051436:Renal Insufficiency, Chronic / Q000451:nursing / Q000628:therapy*; D017582:Renal Replacement Therapy / Q000592:standards*; D000078329:Workforce
keywords: Advanced kidney disease; Haemodialysis; Optimal dialysis starts