Data analysis
Survey responses were summarized using descriptive statistics of frequency, mean, and central tendency using R statistical software.
A directed, emergent content analysis approach was used to analyze qualitative interview transcripts. In directed content analysis, qualitative themes are related to constructs from a theoretical model or framework; themes that are relevant but fall outside the pre-defined set of constructs are also identified and reported.30Two researchers (MRT and SM) developed an initial codebook based on the interview guide, structured by the adapted SDM framework. Together they analyzed one patient and one clinician interview transcript each and discussed the application of codes until consensus was reached, refining the codebook as needed for clarity. The researchers independently coded five additional transcripts from four patient interviews and one clinician interview and participated in an inter-rater reliability test to ensure high reliability. The remaining transcripts were coded by one researcher (MRT), and emerging themes were discussed with the other coding research (SM) during weekly meetings.