{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T16:37:02Z","timestamp":1792859822992,"version":"4.5.0"},"reference-count":52,"publisher":"S. Karger AG","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Nephrol"],"abstract":"<jats:p>Introduction: The clinician-identified barriers to person-centered chronic kidney disease (CKD) care remain poorly characterized among socioeconomically disadvantaged populations. We examined nephrology clinicians\u2019 perspectives on patient preparation, dialysis decision-making, and structural barriers to inform multilevel intervention. Methods: A qualitative descriptive study using semi-structured interviews and thematic analysis included 22 English-speaking nephrology clinicians recruited via snowball sampling. Transcripts were analyzed thematically. Results: Three themes emerged: first, CKD awareness, education, and preparedness \u2013 patient awareness was uneven and often absent even under nephrology care; education was multidisciplinary and stage sensitive but emotionally constrained; second, dialysis decision-making \u2013 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 of approximately 20 mL\/min\/1.73 m2 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; and third, barriers, supports, and clinical management \u2013 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. Discussion: 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.<\/jats:p>","DOI":"10.1159\/ajn\/ablag007","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T11:29:28Z","timestamp":1788521368000},"page":"1-1","source":"Crossref","is-referenced-by-count":0,"title":["Barriers to Person-Centered Chronic Kidney Disease Care: A Qualitative Study of Multidisciplinary Nephrology Clinicians"],"prefix":"10.1159","author":[{"given":"In-Gu","family":"Kang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JoAnn 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