Abstract, title and references:

Is the aim clear?: Yes (See: Furthermore, conversations between dialysis team members and patients about end-of-life planning are uncommon. In this study, they will test the Shared Decision-Making Renal Supportive Care communication intervention to systematically elicit patient and caretaker preferences for end-of-life care so that care concordant with patients’ goals can be provided).

Is it clear what the study found and how they did it?: The study found is fine, but could be more detailed in the abstract? (See: Study outcomes including frequency and timing of hospice referrals, patient and caretaker satisfaction, quality of end-of-life discussions, and quality of death will be assessed over an 18 month period). AND how they did it: All informations, so fine (See: The intervention = prospective cohort with a retrospective cohort serving as the comparison group. Patients from 16 dialysis units associated with two large academic centers in Springfield, Massachusetts and Albuquerque, New Mexico).

Is the title informative and relevant?: Yes, gives you all the necessary information about the study

Are the references: Relevant: Yes, references about the topics. Recent: 5 references (studies) from year 1979, 1989, 1993, 1995 and 1998. The others has a time period up to 15 years. Referenced correctly: Yes Are appropriate key studies included? (I think, yes)

Comments on introduction/background:

Good and relevant background (where references are correct). It is important to look closer on this problem. Definition of specialized terms are written and acronyms written full first and after in parentheses. Overall the structure is optimal.

They make it clear in the background: There is a gap in this area.. (See: patients with ESRD preferred to be given life-expectancy information—even if their prognosis was poor [5, 7]. Furthermore, patients specifically want their physicians to disclose this information without prompting [5]. A validated prognostic tool exists for dialysis patients [8], yet both uncertainty regarding individual prognosis and a lack of training about how to communicate prognostic data has limited EOL discussions between nephrologists and patients.)

Methods:

Fine method: (See: The intervention will be carried out using a prospective cohort with a retrospective cohort serving as the comparison group).

Study sites - relevant informations and a good overview in Table 1: (See: Patients recruited from 16 dialysis units associated with two large academic centers; eight units are affiliated with Baystate Medical Center in Springfield, Massachusetts and eight are affiliated with the University of New Mexico in Albuquerque, New Mexico. Aggregate demographic data for all dialysis units are displayed in Table 1. The institutional review boards at Baystate Medical Center and University of New Mexico approved this study).

Fine overall written study procedures - maybe "Sample size and power" should be before "outcomes"? (See page 5).

Missing Flow Diagram of the selection of participants before page 5? Could give a better overview before? (now on page 5).

Results:

The data is presented in an appropriate way and tables and figures relevant and clearly presented.

Titles fine, columns - could move around between data and results (see module 7).

Are the results discussed from multiple angles and placed into context without being overinterpreted?: The results are discussed to much (overinterpreted).

Do the conclusions answer the aims of the study?: Yes, in between all the text.
Missing the title (heading) with conclusions??

Discussion and Conclusions:

Are the conclusions supported by references or results?: It is fine (bus not clear to find the conclusion?) the text/discussion are good supported with references, figures and tables.

Are the limitations of the study fatal or are they opportunities to inform future research?: They give opportunities to future research. (See: It has the potential to increase hospice use and significantly improve the quality of life for patients with severe kidney disease).