Background and objective End‐stage renal disease (ESRD) affects a multitude of aspects in the patient's daily life, often entailing their own involvement in various aspects of the treatment. Although patient participation is a core health‐care value, what the concept signifies is not yet fully known. The purpose of this paper is to conceptualize patient participation in dialysis care, depicting patients’ and health‐care professionals’ perspectives. Design This explorative study employed qualitative interviews and content analysis. Setting and participants Seven focus group discussions engaging 42 key informants were performed, including patients, staff and managers with experience of dialysis care. Results In dialysis care, patient participation connotes a sharing of information and knowledge, the learning of and planning of care, including partaking in shared decisions with regards to treatment and management, and being involved in the management of one's own health‐care treatment and/or self‐care activities. Although these attributes were illustrated by all stakeholders, their significance varied: patients suggested that their preferences regarding primary aspects of participation vary, while staff considered patients’ performance of dialysis to be the ultimate form of participation. Further, while patients considered multiple ways to execute participation, staff suggested that aspects such as sharing information were a route to, rather than actual, involvement. Conclusions Without a common understanding to denote the idea of patient participation, staff and patients are exposed to a potential deficit in terms of facilitating patient participation in everyday encounters of dialysis treatment. Further studies and means to serve a mutual understanding are needed.

We present experimental evidence of a unique, ordered chemisorption phase in the initial interaction of oxygen with the Al(lll) surface. At high oxygen exposure or high temperature, this phase is shown to transform irreversibly to a bulklike aluminum oxide. The measured temperature dependence, as well as the low-energy electron diffraction, suggests a threefold, centered bonding site. A comparison between calculated and experimental valence-band density of states for the oxygen-covered Al(lll) surface is made for the estimated oxygen-atom-substrate-surface distance.Experimental evidence is presented showing that the initial interaction of oxygen with the (111) crystal face of aluminum is a two-step process. Oxygen atoms are shown to chemisorb first at equivalent sites on the surface in an ordered overlayer. Upon increasing the oxygen exposure or the temperature above 170°C, the chemisorbed oxygen is irreversibly transformed into a bulklike oxide film. The chemisorption phase in the aluminum-oxygen interaction was first observed for "polycrystalline" films. 1 The present work shows that the two-step oxidation process is unique to the closepacked (111) face of aluminum and reveals for the first time the presence of an ordered overlayer with oxygen on a simple fee metalc The other two faces investigated, (100) and (110), form bulklike oxide films for the lowest observable coverages. 2 The existence of a well-defined chemisorption phase on a free-electron-like metal such as aluminum is of great interest since a number of theoretical calculations using different techniques treat chemisorption of oxygen atoms on aluminum as a model system. 3 " 5 Because of the relatively simple bulk electronic structure of this system, calculations have been made self-consistent and have been performed for different adsorbate-substrate distances. Some calculations explicitly assume a specific adsorption site, but comparisons of the calculated valence-band density of states with experimental valence-band photoemission spectra have been hindered by uncertainty about the actual Al-O configurations. In the present work we deduce a specific position and estimate an adsorbate-substrate distance for oxygen atoms on the (111) surface of aluminum. Valence-band spectra obtained for the oxygen-exposed surfaces are compared with a theoretical calculation. 3 ' 6 Discussion of the valence-band spectra for the clean faces is presented elsewhere. 7 The experiments reported were performed using the monochromatized radiation from the 4° beam line at Stanford Synchrotron Radiation Laboratory (SSRL) as the excitation source. Photons at two energies were used to excite electrons: 50-eV photons to excite the valence-band region and 130-eV photons to excite the 2p core of aluminum. Incoming light illuminated the sample at 5°-10° away from grazing incidence. The photoelectrons were energy analyzed in a doublepass, cylindrical mirror analyzer having its optical axis 5°-10° off the sample surface normal; the joint energy resolution (photon plus electron) was 0....

Background: Safe health care of good quality depends on structured and unceasing efforts to progress, promoting strategies tailored to the context, including elements such as patients' preferences. Although patient participation is a common concept in health care, there is yet limited understanding of the factors that facilitate and hinder it in a healthcare context. Aims: This paper identifies what patients and health professionals depict in terms of enablers and barriers for patient participation in dialysis care. Methods: An explorative qualitative design was applied with seven focus group discussions with patients, staff, and managers across different types of hospitals, with the texts analyzed with content analysis. Results: The dialysis context represents three key elements-people, resources, and interactions-that can both enable and hinder patient participation. Both barriers and facilitators for patient participation were found to reside at individual, team, and organizational levels, with a greater number of enabling factors implied by both patients and staff.

Background Patient participation is considered central for good healthcare. Yet, the concept is not fully understood when it comes to patients' experiences of participation in conjunction with their preferences, particularly in long‐term healthcare. The aim of this study was to investigate the extent and variation of preference‐based patient participation in patients with end‐stage kidney disease (ESKD). Methods A cross‐sectional study was conducted with 346 patients in renal care. The main variables were patients' preferences for and experiences of patient participation, determined using the Patient Preferences for Patient Participation tool, the 4Ps. Analyses identified the degree of match between preferences and experiences, that is, the preference‐based patient participation measure. Results Overall, 57%–84% of the patients reached a sufficient level of preference‐based patient participation on the items, while 2%–12% reached an insufficient level. A mismatch indicated either less or more participation than preferred; for example, 40% had less experience than preferred for taking part in planning, and 40% had more than preferred for managing treatment. Conclusion This study shows that, although many patients reach a sufficient level of preference‐based patient participation, this is not the case for all patients and/or attributes. Further opportunities for a mutual understanding of patients' preferences are needed for healthcare professionals to support person‐centred patient participation. Patient or Public Contribution The 4Ps is manufactured in collaboration with people with experience of the patient role, and persons living with ESKD were engaged in identifying their preferences and experiences of participation in renal care.

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