Table 3 A summary of similarities and differences between the Ghanaian setting and that of many high-income countries

 1. Personal values/autonomy central to patient decisions

 2. Support from clinicians, family and friends reinforce ongoing decisions about treatment

1. Decisions to initiate or sustain treatment are mostly driven by hope for a cure in the short-term, rather than an appreciation of the long-term management of the condition

2. Thoughts about how to raise money to finance out-of-pocket payment for dialysis is a concern for many patients in Ghana

3. The number of dialysis sessions is generally reduced to contain costs

4. Accessibility to and availability of RRT is an immediate concern for patients with ESKD in Ghana while those in many high-income countries usually do not have these concerns and may take service provision for granted

5. Palliative care for ESKD is not openly considered as a treatment option in Ghana, as is the case in many high-income countries