Multi-stakeholder Perspective Research Articles

A multi-stakeholder perspective on the development of key competencies for sustainability in Education for Sustainable Development at school

A range of stakeholder groups are involved with fostering Education for Sustainable Development (ESD). It is crucial that their views on the aims of ESD are aligned. This is a prerequisite for coordinated integration of ESD into the formal education system. However, research has not explored whether stakeholder groups have similar ideas about the aims and learning outcomes of ESD. This study investigates the differences and similarities in stakeholders’ opinions on the sustainability key competencies students should develop. We conducted 15 interviews with German experts in ESD practice, policy, and science, analyzing the results deductively using Qualitative Content Analysis within the UNESCO framework of Key Competencies for Sustainability. An inductive approach was used to identify aspects and concepts of competence that went beyond this framework. Most of the competencies mentioned could be assigned to the UNESCO framework, but we identified the additional competency of participating at the political level as being important for ESD. The experts also identified several other concepts. The three stakeholder groups emphasized different competencies and concepts, probably due to their differing professional backgrounds. However, similarities predominated, and the experts largely agreed on which competencies should be developed. Structural difficulties with integrating ESD into the education system are therefore not likely to be the result of fundamental differences in perspective between the three stakeholder groups on the aims of ESD. However, their different frames of reference might lead to miscommunication and misunderstanding, which could impede integration. This aspect needs thorough examination in the future.

Evaluation of sustainable manufacturing performance – A case illustration with multistakeholder perspective

Increasing awareness on achieving the targets of sustainable development goals led to the various discussions on sustainability in manufacturing applications. Sustainable manufacturing has been considered as one of the key factors for achieving sustainable consumption and production. Considering the advantages, sustainable manufacturing has been discussed with various perspectives in order to improve the sustainable manufacturing performances. This study considers one of the perspectives where other studies are limited within the context of sustainable manufacturing performances, multi-stakeholder perspectives. The sustainable manufacturing performances has been collected and evaluated with multi criteria decision making methodology, best worst method. The three multi stakeholder perspectives have been considered for this study which includes manufacturer perspective, customer perspective and government perspective. The collected sustainable manufacturing performances were evaluated based on these different multi-stakeholder perspectives, in order to understand the similarities and differences among multiple stakeholders in the implementation of sustainable manufacturing through its performances. The detailed discussion of obtained results was explored and acknowledged with existing literature support along with the response from case industrial managers. The similarities and differences of opinion among different stakeholders has been explored to provide fruitful contributions to both academic and scientific community. The key managerial implication of this study is that assisting the industrial managers to focus on influential sustainable manufacturing performances instead of focussing less influential ones based on the opinions of different stakeholders.

Multi-governance in higher education: The case of Chile 2018-2023

This article examines the different roles the State/government plays in coordinating the Chilean higher education system. It proposes a conceptual and analytical framework based on a multi-governance approach, which considers multi-level, multi-actor and multi-agenda dimensions. This framework is used to study the different roles played by the State in higher education governance in Chile, especially after the 2018 legislative reforms. The results show an increase in the State's influence on system coordination and that the State/government has strengthened its role as regulator, evaluator and funder of higher education. Similarly, from a multi-level dimension perspective, the results show that the governance of higher education in Chile is highly centralised. At the same time, despite centralising decision-making, the Chilean higher education system is seen as highly complex from a multistakeholder and multi-agency perspective. Lastly, we suggest using this conceptual approach to provide valuable insights for the study of the complexity of governance in higher education systems in other Latin American contexts.

Blended learning and augmented employability: a multi-stakeholder perspective of the micro-credentialing ecosystem in higher education

PurposeProponents of micro-credentials envision them as vehicles for upskilling or re-skilling individuals. The study examines how integrating micro-credentials in the higher education ecosystem enhances employability. It aims to offer insights from the perspective of stakeholders who may benefit from these credentials at an institutional or individual level.Design/methodology/approachOnline in-depth interviews are conducted with 65 participants from India, Nigeria, the United Arab Emirates and the United Kingdom to explore how micro-credentials can be a valuable addition to the higher education ecosystem. A multi-stakeholder approach is adopted to collect data.FindingsThe analysis highlights two possible methods of integrating micro-credentials into the higher education ecosystem. First, micro-credentials-driven courses can be offered using a blended approach that provides a flexible learning path. Second, there is also the possibility of wide-scale integration of micro-credentials as an outcome of standalone online programs. However, the effectiveness of such programs is driven by enablers like student profiles, standardization and the dynamics of the labor market. Finally, the study stipulates that micro-credentials can enhance employability.Originality/valueThe study's findings suggest that, for successful integration of micro-credentials, an operational understanding of micro-credentials, their enablers and strategic deliberation are critical in higher education. Institutions must identify the determinants, address technological limitations and select a suitable delivery mode to accelerate integration. However, micro-credentials can augment employability, considering the increasing emphasis on lifelong learning. An overview of the findings is presented through a comprehensive framework.

Erasmus-driven destination experience and students’ ambassadorship behaviour: A multi-stakeholder perspective

This work aims to a) analyze the tourist experience of Erasmus students in terms of place attachment and b) explore their potential to act as destination brand ambassadors of a hosting destination. It builds on previous literature of international students as tourists, with a wider scope as more publics are involved and both current and future behaviours are explored. Through a qualitative approach run in Valencia (Spain) with three techniques (focus groups, open-ended questions, and personal in-depth interview) we gather information from four stakeholders (current and former Erasmus students, academic coordinators, and students’ tourism managers). By using verbal content analysis, this varied information was coded to answer five research questions. The results revealed accordance among stakeholders around four interconnected dimensions: academic, social, cultural, and personal or psychological. Insights on cognitive and affective place attachment are found, and on both behavioural (returning) and attitudinal (recommending) loyalty. Results from a multi-stakeholder perspective offers insights on the potential of Erasmus students for spreading substantial positive word-of-mouth to more publics than just other students. Building up on the theory of university alumni as a repeat visitor, this paper brings subjective impressions that can help tourist managers to consider Erasmus students as brand ambassadors as they show attitudinal and behavioural loyalty.

The core of secondary level quantum education: a multi-stakeholder perspective

Quantum physics (QP) education at the secondary school level is still in its infancy. Not only is there ongoing discussion about how to teach this subject, but there is also a lack of coherence in the selection of concepts to be taught, both across countries and over time. To contribute to this discussion, we investigated the perspectives of N=39\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$N= 39$\\end{document} high school teachers, university-level physics educators, and physics education researchers regarding the essential concepts in QP and the corresponding illustrations that should be introduced at the secondary school level. We examined the prominence of different key concepts and illustrations, as well as the level of consensus among the various professional groups. Our analysis revealed that certain key concepts are universally valued across all professional groups, while others are specific to particular groups. Additionally, we explored the relationships between these key concepts and their corresponding illustrations. Overall, our study offers valuable insights into the perspectives of different stakeholders, emphasizing the essential concepts and visualizations that should be considered when designing and implementing the teaching of QP at the secondary school level.

“Prison Life Can Make You Go Crazy”: Insights Into the Situation for People With a Mental Illness in the Malawi Prison System

Little is known with regard to due process and forensic assessment capacities in Africa, where over one million are deprived of their liberty on any given day. A rapid situation assessment explored multi-stakeholder perspectives regarding the situation of people with a mental illness in the Malawi prison system. In-depth interviews were conducted with 10 regional professional stakeholders, 18 former prisoners, and five prison staff from two maximum-security prisons. Reflexive thematic analysis yielded five themes; occurrence of mental illness among people living in prison; prison environment exacerbating harm and levels of mental illness; security responses to the presence of psychiatric disorders; availability and coverage of specialist psychiatric and psychological care; and diversion, other non-custodial measures and continuity of care on release. Narratives highlight the substantial causal impact of the prison environment in amplifying existing and new mental illness, vulnerability and exploitation of people with a mental disorder. Malawi prisons are hampered by lack of specialist forensic capacity nationally; centralized mental health surveillance system; and insufficient skilled staff to conduct evidence-based screening and care. Security operations implement the use of pharmacological and physical restraint measures at times. Faith-based organizations play an important role in providing psychological and spiritual support. Release and reintegration require family involvement. A cross departmental intersectoral partnership response spanning government ministries, key civil society organizations, the Malawi Prison Inspectorate and Malawi Human Rights Commission is warranted. Recommendations include alleviation of prison congestion, prison staff capacity building and investment in forensic mental health services with adequate geographic coverage.

Multistakeholder Perspectives of Organizational Aspects Affecting Transition to Practice for Newly Credentialed Athletic Trainers

Context Transition to practice (TTP) is a period of growth in which new athletic trainers (ATs) respond to stressful changes and develop confidence and self-efficacy. Employers have an important role in TTP. Objective To explore multiple stakeholders’ perceptions of ways for organizations to support new ATs during TTP. Design Qualitative study. Patients or Other Participants Athletic trainers from 3 stakeholder groups participated, guided by data saturation: 10 faculty members and 8 preceptors (age = 43 ± 10 years, experience = 11 ± 12 years), 16 supervisors of newly credentialed ATs (age = 52 ± 11 years), and 17 early professional ATs (age = 26 ± 5 years, experience = 9.5 ± 5 months). Data Collection and Analysis Participants were recruited via purposive sampling through an e-mail blast from the National Athletic Trainers’ Association. Participants were interviewed via phone or Web-based platform using a semistructured interview guide. Data were analyzed through consensual qualitative review. Trustworthiness was established via peer review and multianalyst triangulation. Results Four themes emerged. Employers felt they had a responsibility in mentoring new ATs and assisting with professional socialization. Onboarding described the organizational processes used to orient new ATs to their roles, including formal orientation, mentoring, evaluation, and feedback. Additionally, support was provided to new ATs through informal mentoring, relationships with coworkers, and professional development. Support often extended beyond professional needs to address personal challenges. Conflicting priorities occurred when employers wanted to provide more mentoring but were limited from other responsibilities and differences between employees’ and employers’ expectations of work-life balance. Conclusions To build on professional education, employers should provide comprehensive onboarding, formal mentoring, and informal personal and professional support. However, challenges may arise when their own clinical requirements limit the time they can spend mentoring new ATs. Organizations should ensure supervisors have adequate support to assist in the TTP for new ATs. Educators can prepare students to engage in dialog on work-life balance, expectations, and compensation to assist with TTP.

Decoding Success in IT projects: a Multi-Stakeholder Perspective

Purpose–This study evaluated how effectively key stakeholders (project managers, team members, and clients) could predict I.T. project success. Every stakeholder had an independent perspective on the project's success, which made it possible to evaluate the project's success by considering all the stakeholders' points of view. Study Design/Methodology/Approach–Two focus groups studied how project managers, teams, and clients could determine I.T. project success. The study focused on assessing I.T. project success from various perspectives. Five to six stakeholders from different sectors with personal experience in I.T. projects participated in that study. Findings – The results suggested that successful I.T. projects that met business goals, improved operational efficiency, and produced significant returns on investments depended upon communication and teamwork, and equal participation by all stakeholders, the project success would be improved. Practical Implications – The research implications for project management strategies are that organizations could enhance their capacity to work together and achieve project goals by incorporating multiple stakeholder perspectives. This approach promoted creativity and encouraged IT solutions that aligned with business objectives. Originality/Novelty – Project managers monitored I.T. project execution to balance corporate goals with technology demands. Project teams produced high-quality deliverables and communicated well to overcome difficulties. Clients preferred I.T. solutions that met their company objectives, improved operational efficiency, and provided significant ROI.

A framework of HRM in cooperatives: A systematic literature review and future research agenda

Cooperatives, as democratic organizations owned and controlled by their members, pose distinctive challenges in the realm of human resource management (HRM). These challenges stem from their commitment to serving the diverse interests of multiple stakeholders and the fundamental differentiation between member and non-member employees. In an era where sustainability and a multi-stakeholder perspective have gained prominence in HRM research, cooperatives offer an ideal context for exploring these dynamic developments. Through a comprehensive synthesis of existing literature, this review seeks to construct an HRM framework that is tailored specifically to cooperatives. It highlights how the distinctive characteristics of cooperatives, such as member self-leadership, self-control, and adherence to cooperative values and principles, shape HRM policies and practices. The insights derived from this study provide implications for guiding future research in the domain of HRM within the cooperative sector.

Indigenous Games as a Catalyst for Sport Tourism Development in South Africa

This preliminary study seeks to investigate the role of indigenous games as catalysts for sport tourism development in South Africa. By employing a mixed-methods approach, qualitative data will be gathered through in-depth interviews with key informants, including government officials responsible for cultural affairs, organizers of indigenous games, and various stakeholder groups. Quantitative data on its part will be sourced from residents in host communities and from event participants and spectators. By examining multi-stakeholder perspectives on the phenomenon, the research aims to provide a comprehensive understanding of how indigenous games can be utilised as tools for sport tourism development in South Africa. The anticipated outcomes of the study include insights into the ways indigenous games can enhance South Africa's appeal as a sport tourism destination. Understanding key stakeholders’ perspectives regarding indigenous games could reveal the potential areas of leveraging indigenous games for sport tourism. The implications of this research could be far-reaching, offering guidance to policymakers, tourism boards, and cultural organisations involved in their hosting. By recognizing the value of indigenous games in the broader context of sport tourism, stakeholders could develop strategies to promote sustainable tourism practices, preserve cultural heritage, and foster inclusive economic growth. This study's outcomes should contribute to the ongoing discourse on the intersection of culture, sports, and tourism, emphasising the importance of indigenous games as a unique and underexplored asset in South Africa's sport tourism landscape. Ultimately, the findings could inform initiatives that capitalise on the synergies between cultural heritage and tourism for the benefit of both local communities and the broader South African economy.

Studying Disability: A Multi-Stakeholder Perspective on Requesting Accommodation in Higher Education

Including students with disabilities in higher education is a global political objective and is considered a human right. However, many students do not feel included and hesitate to ask for the help they need to succeed in their education. This study aims to investigate the processes of requesting accommodation for students with disabilities in higher education from the perspectives of both students and support providers. Six co-creation workshops were held, with a total of 46 participants from various backgrounds relevant to exploring pathways for students with disabilities in higher education and into the workforce. The audio recordings of the workshops were analyzed using a constructivist grounded theory approach to identify and explore processes. Three interconnected processes were identified: determining whether to disclose, asking for accommodations, and studying disability. The analysis showed that these processes could be time-consuming and riddled with barriers, and they did not always result in granted accommodations. Some students ended up using their study time to research their disability and potential accommodations instead of studying their subject matter. To eliminate barriers and promote disclosure, universities should ensure a universally designed education and that staff have the necessary knowledge to assist students in obtaining accommodations.

Publication Recommendations to Report Laboratory Data of Neonates – a Modified Delphi Approach

BackgroundClinical and analytical information on laboratory data of neonates in scientific publications is sparse and incomplete. Furthermore, interpreting neonatal laboratory data can be complex due to their time-dependent and developmental physiology, and paucity of well-established age-appropriate reference ranges for neonates. This study aims to develop publication recommendations to report laboratory data of neonates to enhance the quality of these data in research and clinical care.MethodsA modified Delphi approach was used to develop recommendations in cooperation with the International Neonatal Consortium. A Core Group, including different stakeholders, was responsible for developing the recommendations, in collaboration with a Reflection Group, responsible for providing additional input.ResultsThe recommendations were classified into three categories: ‘Clinical Characteristics’, ‘Bio-analytical Information’ and ‘Data-analytical Information’. These were each divided into ‘Core Data’ (always to be reported) and ‘Supplemental Considerations’ (to be reported when considered relevant to the study).ConclusionOur recommendations provide guidance on standardization of neonatal laboratory data in publications. This will enhance the comparison, replication, and application of study results in research initiatives and clinical practice. Furthermore, these recommendations also serve as foundational work to develop reference ranges for neonatal laboratory values by standardizing the quality of information needed for such efforts.ImpactStandardized reporting of neonatal laboratory data in scientific publications will enhance the comparison, replication, and application of study results in research initiatives and clinical practice, as well as improve reporting to regulatory agencies.To integrate multistakeholder perspectives, a modified Delphi approach was used to develop publication recommendations which strengthens the applicability of the recommendations.Implementation of standardization will likely improve the overall quality of neonatal clinical research and neonatal healthcare.In addition, these recommendations are foundational to develop reference ranges for neonatal laboratory values by standardizing the quality of information needed for such efforts.

Stakeholder Responsible Behavior in Tourism: Scale Development and Validation

The stakeholder responsible behavior (SRB) scale is a recently developed measurement scale designed to assess individuals’ responsible behavior. The present study seeks to conceptualize and validate the SRB scale. A number of tourism stakeholders are now working together to develop sustainable tourism practices at the destination. Furthermore, only a few studies have examined stakeholder responsibilities in tourism. Therefore, this study attempts to conceptualize stakeholder responsible behavior in tourism from a multistakeholder perspective using the triple bottom line (TBL) theory. In order to assess the responsible behavior of stakeholders in a comprehensive manner, we developed a measurement scale. In the study, responses were collected from two stakeholder groups, residents and tourists. Following that, statistical techniques were used to evaluate the scale’s reliability and validity. According to the results, assessing the behavior of stakeholders in three dimensions is vital for achieving sustainability status within destinations. Based on the scale validated by this study, destination management organizations (DMOs) will be able to bring multiple stakeholders together to evaluate underlying sustainability issues and develop solutions.

A qualitative exploration of multi-stakeholder perspectives of before-school physical activity

BackgroundEngagement in before-school physical activity can potentially enhance health and learning-related outcomes for children and adolescents. However, influencing factors and stakeholder perceptions of before-school physical activity remain under-researched. This qualitative study aimed to examine stakeholder perceptions of: a) the suitability of the before-school segment for physical activity, b) barriers and facilitators associated with before-school physical activity, and c) strategies for schools to support before-school physical activity.MethodsTwelve focus groups and one interview were conducted with 38 participants from a range of school stakeholder groups—students, parents, teachers, school leaders, external physical activity providers, and school health and physical activity experts. Focus groups were analysed using template analysis, guided by a social-ecological model.ResultsStakeholders perceived before-school physical activity as valuable, for reasons including perceptions of meaningful contributions to students’ cognitive functioning, classroom behaviours, and wellbeing. Factors influencing before-school physical activity were identified across multiple social-ecological levels, including the critical role of school leadership support, availability of facilities, and provision of qualified supervision. Proposed strategies highlighted the need for sustainable design, contextual relevance, and community engagement in before-school initiatives. Additionally, communication of the manifold benefits identified by stakeholders was suggested as a means to drive support and engagement in before-school physical activity.ConclusionsThis study provides insight for schools seeking to enhance opportunities for physical activity in the before-school hours and may inform future intervention research on the subject, taking into account its multi-faceted influences and the need for context-specific strategies.

"I think we did the best that we could in the space:" A qualitative study exploring individuals' experiences with three unconventional environments for patients with a delayed hospital discharge.

Given growing hospital capacity pressures, persistent delayed discharges, and ongoing efforts to improve patient flow, the use of unconventional environments (newly created or repurposed areas for patient care) is becoming increasingly common. Despite this, little is known about individuals' experiences in providing or receiving care in these environments. The objectives of this study were to: (1) describe the characteristics of three unconventional environments used to care for patients experiencing a delayed discharge, and (2) explore individuals' experiences with the three unconventional environments. This was a multi-method qualitative study of three unconventional environments in Ontario, Canada. Data were collected through semi-structured interviews and observations. Participants included patients, caregivers, healthcare providers, and clinical managers who had experience with delayed discharges. In-person observations of two environments were conducted. Interviews were transcribed and notes from the observations were recorded. Data were coded and analyzed thematically. Twenty-nine individuals participated. Three themes were identified for unconventional environments: (1) implications on the physical safety of patients; (2) implications on staffing models and continuity of care; and, (3) implications on team interactions and patient care. Participants discussed how the physical set-up of some unconventional spaces was not conducive to patient needs, especially those with cognitive impairment. Limited space made it difficult to maintain privacy and develop social relationships. However, the close proximity of team members allowed for more focused collaborations regarding patient care and contributed to staff fulfilment. A smaller, consistent care team and access to onsite physicians seemed to foster improved continuity of care. There is potential to learn from multi-stakeholder perspectives in unconventional environments to improve experiences and optimize patient care. Key considerations include keeping hallways and patient rooms clear, having communal spaces for activities and socialization, co-locating team members to improve interactions and access to resources, and ensuring a consistent care team.

A Multi-Stakeholder Perspective on the Limitations of Implementing Artificial Intelligence in Highway Transport

This research paper explores stakeholders' perspectives on the challenges associated with implementing Artificial Intelligence (Ai) in highway transport. The investigation focuses on three main areas of limitation: technical, regulatory, and ethical barriers. The study, backed by an in-depth survey analysis, reveals key limitations identified by stakeholders, including limited access to Ai technology (42.6%), lack of government support (27.9%), the absence of industry-wide regulations (27.4%), concerns about job displacement (29.4%), privacy implications (25.5%), and cybersecurity risks (30.2%). Additionally, the paper provides recommendations for policymakers, industry stakeholders, and researchers to address these challenges [1].

Untangling the critical success factors of the latest compulsory waste sorting initiative in Shanghai: The role of accountability governance

Municipal solid waste sorting is an essential element of urban sustainability as cities transition to a circular economy. As a mega-city, Shanghai has achieved remarkable milestones in its latest compulsory waste sorting program. This success has garnered widespread attention, and most studies have primarily focused on policy interventions from either a macro perspective or micro-analysis of individual behaviours. However, these studies have often overlooked the intricacies of multi-stakeholder coordination and the division of responsibilities, which frequently contributed to the failure of waste sorting initiatives. Furthermore, existing research lacks a systematic theoretical framework to elucidate multi-stakeholder accountability mechanisms. Therefore, this research adopts a case study approach to untangle the factors that led to Shanghai's success. Through the lens of accountability theory, this study systematically elaborates stakeholder accountability mechanisms and offers a distinctive multi-stakeholder perspective to explain Shanghai's success across vertical, horizontal, and felt accountability dimensions. This informative exemplar provides crucial empirical insights for other cities, especially those grappling with challenges in promoting and managing waste sorting initiatives.

Mobile Payment Applications in Countries with Low Financial Inclusion: A Multi-stakeholder Perspective Review

Aims: Mobile payment apps have become the most used mobile payment system, especially in underbanked regions. It has come be the most viable way of promoting access to and use of quality financial services, at affordable cost. As far as review works on use/adoption of mobile payment apps in low financial inclusion countries go, presentation has been from users’ perspective. Thus, under-emphasizing the challenges of other members of the m-payment app ecosystem. The work aims at describing such general challenges from the lenses of users, regulators and merchants of mobile payment apps. Also, pros and cons of some specific mobile payment apps in these regions are also provided in the work. Place and Duration of Study: The review covered literature covering m-payment adoption in low financial inclusion countries i.e. Asian and African countries, spanning 2015 to 2023. Methodology: In selecting the literature, we considered only journal publications considering specifically m-payment apps, and written in English. To achieve a measure of spread, major regions in the two continents were considered, and journal articles focusing on a particular country were limited to two. Conclusion: We observe that the challenges of m-payment apps from users’ perspective are mostly denser than other perspectives. Users’ and regulators’ concerns converge only so thinly. Only regulators’ task of enlightenment of users/customer of about demonetization policies mirrors one of users’ concerns, perceived trust. Users and merchants are both concerned with perceived risk and perceived ease of use concerns. The challenges of regulators as regards m-payment apps are quite dissimilar to those of merchants. In all, the observed disparate (or thin similarity of) concerns of the different m-payment app stakeholders strengthens the need for such an inclusive review done in this work.

Unravelling complex choices: multi-stakeholder perceptions on dialysis withdrawal and end-of-life care in kidney disease

BackgroundFor patients on dialysis with poor quality of life and prognosis, dialysis withdrawal and subsequent transition to palliative care is recommended. This study aims to understand multi-stakeholder perspectives regarding dialysis withdrawal and identify their information needs and support for decision-making regarding withdrawing from dialysis and end-of-life care.MethodsParticipants were recruited through purposive sampling from eight dialysis centers and two public hospitals in Singapore. Semi-structured in-depth interviews were conducted with 10 patients on dialysis, 8 family caregivers, and 16 renal healthcare providers. They were held in-person at dialysis clinics with patients and caregivers, and virtually via video-conferencing with healthcare providers. Interviews were audio-recorded, transcribed, and thematically analyzed. The Ottawa Decision Support Framework’s decisional-needs manual was used as a guide for data collection and analysis, with two independent team members coding the data.ResultsFour themes reflecting perceptions and support for decision-making were identified: a) poor knowledge and fatalistic perceptions; b) inadequate resources and support for decision-making; c) complexity of decision-making, unclear timing, and unpreparedness; and d) internal emotions of decisional conflict and regret. Participants displayed limited awareness of dialysis withdrawal and palliative care, often perceiving dialysis withdrawal as medical abandonment. Patient preferences regarding decision-making ranged from autonomous control to physician or family-delegated choices. Cultural factors contributed to hesitancy and reluctance to discuss end-of-life matters, resulting in a lack of conversations between patients and providers, as well as between patients and their caregivers.ConclusionsDecision-making for dialysis withdrawal is complicated, exacerbated by a lack of awareness and conversations on end-of-life care among patients, caregivers, and providers. These findings emphasize the need for a culturally-sensitive tool that informs and prepares patients and their caregivers to navigate decisions about dialysis withdrawal and the transition to palliative care. Such a tool could bridge information gaps and stimulate meaningful conversations, fostering informed and culturally aligned decisions during this critical juncture of care.