Table 5 Predictors of a good outcome and methods of assessment, derived from reflexive interpretative analysis

Physical factors

 ● prominent uraemic symptoms that may be relieved by dialysis (e.g., nausea, anorexia)

 ● low levels of pre-existing frailty/physical dependence

 ● absence of pre-existing significant symptoms that are unlikely to be relieved by dialysis (e.g., chronic pain, depression)

 ● the ability to tolerate dialysis, particularly fluid removal

 ● a functional access for dialysis which is not problematic to use/maintain

Psychological factors

 ● lack of conflict or ambiguity around the decision to start dialysis

 ● expectations from dialysis that are reasonable and achievable

 ● illness perception - an internal locus of control, willingness to take responsibility for own health

 ● understanding of dialysis treatment and need for lifestyle changes, food/fluid restrictions

 ● actively choosing a positive attitude; not “giving up”, willingness and opportunity to adapt to changing circumstances

 ● hopeful; engaged with the future; “meaning and purpose” in life

Social factors

 ● family as motivation: providing physical/psychological support, family that requests continuance on dialysis or other treatment, participants who continue dialysis in order to be able to look after their family members

 ● involvement of close family/friends/carers in daily life, in healthcare decisions

 ● participants who derive social benefit from interactions of the dialysis unit (particularly if socially isolated)

 ● ability to travel or engage in other activities (personal or social) separate from dialysis

Healthcare provider/institutional/societal factors:

 ● positive relationships with healthcare providers, where patients feel valued and listened to

 ● appropriate skill sets among medical and nursing staff

 ● opportunity to consider or participate in advance care planning

 ● patient-friendly staff and dialysis facilities (e.g., flexible schedules, comfortable chairs, adequate heating)

 ● easy access to dialysis facilities, including proximity, transport arrangements

 ● financial stability or lack of financial penalties from being on dialysis

 ● access to social/formal community support that is affordable and always available