71 major cognitive problems and terminal illness were reasons for exclusion. We aimed for sample heterogeneity by recruiting 1) native and non-native Dutch speakers, and 2) patients with and without co-morbidities. We accepted an overrepresentation of people with lower education and males, since these are predictors of LHL[3] and risk factors for becoming dialysis dependent[42]. For HCPs, we included GPs and specialized nurses in primary care, and nephrologists, specialized nurses, dieticians and social workers in secondary care. Together these are responsible for Dutch CKD care. Figure 3.1 gives details on our recruitment and study procedure. We first approached HCPs by e-mail and phone to ask for informed consent. First, we included ten HCPs representing every professional background. Second, we recruited twelve new representative HCPs for the FGDs in phase 2. Last, we approached all previous participants to contribute to three final FGDs, of which ten refused with reasons, i.e. lack of time, new profession, and personal circumstances. Therefore, additionally, we recruited four GPs, two nephrologists, three nurse specialists and one nurse to join the FGDs. Patients were recruited via seven participating HCPs to participate in both in-depth interviews. These HCPs received a checklist, explaining predictors and signs of LHL[3,43]. They approached 47 eligible patients by phone or during consultations. Patients with interest received an information letter. The main researcher (MDB) called them to give additional information. 28 patients provided informed consent of whom four with adequate HL were excluded, based on the AAHLS[41]. Nineteen patients did not consent with reasons, i.e. not interested in participation, disease burden or uncertainty about their ability to contribute. Participating patients received a gift card of 10 Euros.
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