Table 4 Content of educational interventions

Giving an objective overview of options

Establishing a trusting relationship

Verifying patients prior knowledge together with their desire for information

Working to an individualized approach (more ‘counseling’ rather than ‘education’, with regard to time and content, e.g. discussing impact on the daily life)

Encouraging patients to participate in the decision (increasing confidence)

Training health care staff in emotional support (e.g. leaving room for fear/doubt of patients)

Improving skills in bringing bad news

Engaging relatives, and learning how to deal with informing relatives

Making patients and their relatives reflect (listing pros and cons)

Using straight-forward language

Summarizing regularly, checking for understanding, and clearly identifying the next steps

Improving clinical expertise for all health care providers, ensuring that informal in-hospital conversations are not biased

Creating pre-dialysis opportunities to talk to patients already on dialysis

Fine-tuning decision support tools

Ensuring private space and taking time for each patient, though considering an accurate workflow

Improving cultural and spiritual understanding and support

Reflecting in group about ethical dilemmas

Routinely establishing prognosis through prediction instruments

Providing consecutive appointments, also once patients have started (some patients may think about switching from modality)

Offering advanced care planning early in the disease

Assisting patients to complete advance care directives

Training in palliative support, avoiding therapeutic persistence

Obtaining greater institutional engagement

Focusing on multidisciplinary cooperation and discussion meetings