Barriers to Person-Centered CKD Care: A Qualitative Study of Multidisciplinary Nephrology Clinicians

The clinician-identified barriers to person-centered chronic kidney disease (CKD) care remain poorly characterized among socioeconomically disadvantaged populations. We examined nephrology clinicians' perspectives on patient preparation, dialysis decision-making, and structural barriers to inform multilevel intervention.

A qualitative descriptive study using semi-structured interviews and thematic analysis following Braun and Clarke's (2006) approach [29] included 22 English-speaking nephrology clinicians recruited via snowball sampling. Transcripts were analyzed thematically.

Three themes emerged. First, CKD awareness, education, and preparedness: patient awareness was uneven and often absent even under nephrology care; education was multidisciplinary and stage-sensitive but emotionally constrained. Second, dialysis decision-making: planned outpatient initiation was distinguished from unplanned emergency starts, the latter associated with reduced patient choice and worse outcomes; modality discussions typically began at an estimated glomerular filtration rate (eGFR) of approximately 20 mL/min/1.73m² but timing varied widely; nephrology clinicians sometimes omitted home dialysis options when patient support seemed uncertain; and family involvement was central to adherence and decision quality. Third, barriers, supports, and clinical management: nonadherence reflected structural barriers, financial hardship, health literacy, transportation, and delayed referral, rather than motivation, while the clinician-patient relationship was a modifiable adherence determinant limited by understaffed support services.

Nephrology clinicians identified patient awareness, education timing, provider variability, and structural barriers as modifiable determinants of inequitable CKD outcomes. Multilevel intervention targeting pre-dialysis education, primary care coordination, reimbursement reform, and social support infrastructure is needed.