Treatment Decision-Making in Myocardial Infarction for People With Advanced Kidney Disease: Protocol for a Qualitative Study

Background: People with chronic kidney disease (CKD) have significantly higher morbidity and mortality following myocardial infarction (MI) than the general population. Despite this, they are less likely to receive invasive management and guideline-directed medications than those without kidney disease. It is unclear why this treatment variation exists and whether or not it reflects equal and appropriate access to care for the high-risk CKD population. Aims: The aims are to (1) understand how management decisions following an MI are made for, and with, people with CKD, and (2) describe the experiences of people with CKD who have recently received MI care in England. Method: We will recruit 15-20 patients with CKD and previous MI, and 15-20 clinical staff who are involved in treatment decision-making, from 3-5 NHS hospital trusts in the UK. Purposive sampling will be used to ensure diversity in participants with respect to age, gender, ethnicity and, where relevant, profession or degree of kidney impairment. We will undertake semi-structured interviews following flexible topic guides developed for patients and clinical staff. Interviews will be audio-recorded and transcribed. Transcripts will be analysed using the six steps outlined in Braun and Clarke's thematic analysis, within an interpretivist, constructionist approach. Analysis will be primarily inductive. We will label sections of text with codes to reflect semantic or latent meaning and cluster similar codes together to derive themes which we will define and name. We will produce a report comprising themes central to MI treatment decision-making in people with CKD, illustrated with examples of data and analytic commentary, and demonstrate where our research stands within the context of the literature and wider context.