Background <p>It is critical to ensure that older patients and families understand the risks and benefits of each available treatment option when contemplating kidney therapy (KT) decisions. This study investigates older patients’ and caregivers’ beliefs regarding chronic kidney disease (CKD) curability, anticipated quality of life (QoL) with dialysis, trade-offs between longevity and QoL, frequency of prognostic discussions and views on remaining life expectancy.</p> Methods <p>We conducted secondary analyses of orally administered questionnaire-based data collected in two intervention studies aimed at improving KT decision-making for older adults with advanced CKD.</p> Results <p>We present descriptive statistics to summarize findings. Among 118 patients (mean age 79 years) and 60 caregivers (mean age 68 years), 54% patients and 75% caregivers were women, with 75% patients and 79% caregivers identifying as White. When asked about their CKD curability, nearly 35% patients and 15% caregivers did not know or were unsure, while 10% patients and 12% caregivers expressed optimism. Participants generally lacked clarity on dialysis’s impact on QoL. Furthermore, most participants (85% patients and 92% caregivers) did not have prognostic discussions about life expectancy with their nephrologists and were either uncertain or optimistic about future 1 and 2-year survival rates. Many participants prioritized QoL—functional status (45% vs. 48%), reduced suffering (70% vs. 24%), and fewer hospitalizations (48% vs. 45%)—over choosing dialysis.</p> Conclusion <p>Inaccurate beliefs about CKD curability, the benefits of KT options, lack of prognostic discussions and prognostic uncertainty are common among older adults and caregivers facing treatment decisions, highlighting the need for educational interventions for nephrologists, patients and families.</p>