2.1| Study design and participant population
We conducted a qualitative descriptive study between 5/2019 and 10/2019
at three affiliated hospitals of Zhengzhou University. The three were
public hospitals designated by local medical insurance department. We
recruited two groups of respondents including a purposive sample of
patients with advanced CKD and a convenience sample of nephrologists.
The inclusion criteria for advanced CKD patients were 1) aged 18 or
older; 2) eGFR<20 mL/min/1.73m2; 3)
patient-initiated referral; 4) able to communication in Chinese;
Exclusion criteria were :1) acute kidney injury; 2) be on regular
dialysis; 3) inability to communicate (e.g. cognitive impairment); The
inclusion for nephrologists were:1) provision medical services to
patients with advanced CKD;2) at least 5 years of clinical experience;
Purposive sampling captured variation in age, self-referral number, CKD
stage. All eligible participants invited to interview gave full informed
consent. Sampling continued until data saturation, i.e. no new themes
were identified in later interviews21.
Nephrologists were recruited via telephone or email by study coordinator
(Shan, Y). Interested nephrologists agreed to participant this study.
Another researcher (Gao, Y J) approached self-referral patients with
advanced CKD after first staff-patients meeting about treatment
decision. The recruitment strategy was adapted according to suggestion
of clinical managers and clinic schedule. Study coordinator obtained all
participants’ written inform consent and scheduled interviews.
Face-to-face interviews were conducted at a private room and each
interview lasted approximately 50 min.