Table 2 Analytical process from text segments to themes

Patient participation when dialysis is initiated

As a rule, we let patients choose the modality they want. Of course, you can try to influence them a bit towards the direction you think wise. If people are active, we promote home-based treatment. However, the patients themselves should make the final choice. (Participant G)

Laypeople don’t usually know anything about kidney failure and dialysis, or the difference between HD and PD – it all depends on what information they get… and we think it’s okay to start with PD…so I would say it’s a slightly steered choice. (Participant H)

We present peritoneal dialysis in a slightly more positive way than haemodialysis. In this county, we have less home dialysis than recommended. Thus, we may be pushing the patients a little towards home treatment, to meet the policy goals. (Participant D)

A slightly steered choice

The challenge of guiding treatment choices

I must become familiar with patients’ daily lives to the extent that is possible. I then inform about the different options. I would say it’s sort of a process, a dialogue, where I challenge the patients with questions to get to know their priorities. (Participant I)

I ask about the situation at home. Whether they have kids and whether they want to continue work. And if there are other things that are important to them. And then it’s important to get them well informed about both the dialysis modalities. (Participant A)

A shared decision

Patient participation in haemodialysis

As a haemodialysis patient, you can of course participate in your own treatment. You can learn to cannulate the fistula, to set up the machine and to a certain extent run the dialysis. (Participant D)

They must be allowed to make informed choices. They must know why we do things and why they get this treatment, the point of coming here so frequently, the point of the medications. (Participant F)

Participation through self-management

Negotiating patient participation within a professional frame

We don’t feel that all of them have enough knowledge about the treatment to have an opinion about it [the fluid removal], so no, we don’t always discuss it with them. (Participant F)

Dialysis isn’t a pre-set treatment impossible to adjust to individual needs… many are unaware of that... but dialysis is about so much more than just prescribing a time-scaled treatment with this or that dialysate solution and this or that filter [dialyzer membrane]. (Participant I)

Negotiated values

You want to provide flexibility, but it is not always possible when you don’t have enough machines and there are cutbacks in addition and - it just makes it difficult. (Participant A)

If you are concerned with people and your patients, you should be concerned with patient participation as well. However, it takes more of your time. If you just decide on behalf of the patients, you get things done faster. (Participant G)

Hindrances for patient participation