Table 2 Selected illustrative quotes

Inconsistent awareness of peer support opportunities

“Maybe once or twice since I’ve worked in the kidney clinic in the last 3 years that I can remember have I heard a nurse say, ‘I told this patient about the peer support program’. They might be doing it. I mean, we all work in the same office. I overhear a lot of their conversations, [but] I haven’t heard them talk about it. I don’t know if the nephrologists talk about it… I don’t think anyone else is talking about it except for me.” – Social worker 1

“I wouldn’t say there’s a lot of awareness. There tends to be around some of the social workers and among those who know the program exists, and we certainly have the pamphlets out there and the information generally available. I wouldn’t say the nursing staff or the dietary staff or the admin staff would be aware of the scope of the program or how to get people connected with it.” – Social worker 3

We don’t know enough about peer support programs and how to train somebody and all these kinds of things…I don’t know much about it; I’ve never attended or anything like that.” – Social worker 5

“I know that they [peer support organization] have the telephone support and an internet program and then I have no idea what goes on in other areas of Canada, but in [city] there was a coffee group started that of course is on hold now because of the pandemic.” – Nurse 2

“I’m not 100% sure of the differences…I think it’s basically the same idea where they you have a person [patient] who is interested in peer support, and then they match you up with someone who [they] think they would be compatible with.” – Manager 1

Logistics of peer support integration in multi-disciplinary care

“We have 1500 patients and there’s one of me, and if I’m the only one who is talking about peer support, I can’t get to everyone… There [isn’t] always a lot of time for me to talk to people. I may be addressing their financial concerns and that is paramount in that moment, rather than being able to look into deeper at those people’s needs and even think about offering peer support.” – Social worker 1

“I think it would be likely that they [patients] use a peer support program if they knew more about it and we were trying to refer everyone to it.”- Social worker 2

“I mean it’s easy to go there [peer support group] and be a guest speaker but doing the recruiting and organizing of space and then mentorship of clients who are willing to be volunteers, that takes a lot of work. The people who are working in these [CKD] programs don’t have enough time to do it off the side of the desk. – Social worker 7

“It’s sort of frustrating because there will be times where you think, ‘I really wish I could take your name and number and give [it] to this person’, or I could [say], ‘You two could get together and start a Facebook group’. But we can’t do that.” – Nurse 2

“I think it [peer support] should be reintroduced because our [CKD] patients change over time…I think it [peer support] basically should be like something that they [clinic staff] check off every time, or it should be introduced periodically, ‘are you sure you now don’t need a bit of peer support.’ – Nephrologist 1

Recognition of patient accessibility concerns

“[Peer support program] doesn’t have people who speak languages other than English, which is a huge barrier for people who don’t speak English, and we do have one or two buddies who speak another language besides English.” – Social worker 1

“I haven’t asked, but my thoughts would be [patients] feeling overwhelmed with everything that’s going on. Whether it’s their health or work, just having to do one more thing we are asking them to do. I’ve spoken to a peer support volunteer where she says she hands out her phone number all the time to patients for them to call and she doesn’t even get phone calls.” – Social worker 8

“Sometimes when we are dealing with things geographically in addition to ease with technology. Sometimes you are trying to help those people, but you can’t get it [peer support] to them because them can’t understand or don’t have access to those technologies… We don’t have those teleconference places where people can go into the hospital and use those resources, or they can’t go to the library and use them there.” – Nurse 1

“I promoted that [coffee group] a lot…many didn’t want to drive in from 90 min away for one more thing or were 4 h away so that just won’t work, but really wishing that there was someone [peer] or something [program] that they could make use of.” – Nurse 2

“We have people who don’t want the support and think that everything is okay.” – Manager 1

Integrating support pathways

“I tend to see peer support as part of the team atmosphere. The CKD team’s role is managing the medical needs, psychosocial needs...peer support is more of an adjunct, another layer to the program of being able to answer the questions of what the actual patient experience might look like.” – Social worker 3

“Our patient groups are in silos as well. We [CKD clinic staff] don’t really hear. It’s not often that our peritoneal dialysis folks will be interacting with our hemodialysis folks or they will be come over here [CKD clinic] and interact with our [patients], Even though we are a big department we are kind of on our own at the same time.” – Social worker 6

“I think it would be really useful to liaise with [peer support organization] because they have put so much work and time into a formal program. Then connecting them with social work because they connect with the [organization] for funding support and so they do have a bit of an existing communication process.” – Nephrologist 2

“I think that it would be a great thing to have someone [peer mentor] readily available… Prior to us moving to this location, if we had a patient that was struggling whether or not to get a fistula, there are particular patients that we know that would be more than willing to speak to patients and show them what their fistula looks like. We could easily find out, well, Jane Doe is on dialysis today, I’ll go and ask that person, ‘Can we have a look at your fistula?’ And if so, let’s go have a look.” – Nurse 3

“We do have volunteers here as well. They don’t always come down to clinic, but I guess that is something they probably could start doing. You could do a little visit. It’s more up on our in-centre hemo[dialysis] where they provide a chat or provide tea or coffee… This is a way for them to keep connected with everybody. It would probably help to have them go down to [CKD] clinic and share a few stories, especially on our education days.” – Manager 2