Summary of belief statements and sample quotes from physicians assigned to domains identified as relevant
| Domain | Specific belief | Frequency (out of 13) (n (%)) | Sample quote |
| Environmental Context and Resources | Time is a concern/factor in my decision to participate. | 13 (100) | ‘Well if it takes a lot of time, which we don’t have a lot of the time that would be a real disincentive to do it’ (P1). |
| I would require a research assistant, another colleague or specialist. | 12 (92) | ‘…the #1 factor driving me to participate is the support I would receive on-site, that would influence me to make the decision in participating. I foresee if we would have supporting staff, for example to take consent, help compile screening questions, to form (an) excel sheet to ensure follow-up/booking and all those little logistics will be taken care of (by) somebody else….’ (P4) ‘… there would probably have to be a physiotherapist for checking function and an occupational therapist checking the actual outcome measures like speed and dexterity…’ (P6) | |
| I would require resources such as information, training, education, learning materials, the protocol and so on. | 9 (69) | ‘Well I guess training on the specific screening tool used. Probably some basic training like research ethics training …’; ‘Education on the actual screening process and the screening tool. And potentially educational information on what the functional assessment measure we’re using [is]. And probably just an outline on the actual trial or protocol that’s expected in terms of follow-ups, the amount of time, the duration of follow-up, and also the study protocol’ (P10). | |
| Funding/cost/remuneration is a factor in my decision to participate. | 8 (62) | ‘It would make my waitlist longer and again, I would not do it if it's not remunerative’ (P3). ‘We would need the funding to hire staff to do those outcome measures…and then are we allowed to bill [payment system] for this kind of follow up?’ (P4). | |
| I would need other tools/support. | 7 (54) | ‘… To do this kind of study, you need some facility support. The time and the place that you’re doing the screening, that would have to be provided somewhere’ (P13). ‘Umm I don’t think I need to be influenced, but I need to be supported by the hospital…’ (P4). | |
| Intention | I would consider screening my patients if this trial is available in the next year. | 13 (100) | (Would you screen your patients as part of a trial of MSCs for clinical stroke if one is available in the next year?) ‘If it was shown to be safe, I would help yeah’ (P2). ‘Yeah. (And why’s that?) I have patients interested in it. And I think it’s an important question for us in rehabilitation’ (P12). |
| I may not participate in the trial. | 1 (8) | ‘I just don’t see myself engaging in that research’ (P13). | |
| A phase 1 vs phase 2 trial would not affect my motivation to participate in a negative way. | 7 (54) | ‘I feel this safety trial is necessary, it is motivating for me’ (P4). ‘I would still be motivated to do it, but I would just want to make sure that the educational material is reflective of the goal of the trial and that patients understood exactly what they were getting involved in’ (P10). | |
| A phase 1 vs phase 2 trial would affect my motivation to participate. | 6 (46) | ‘Yeah I don’t think I would be that motivated to do that because I’m in a rural setting and if there are complications or challenges or problems with the injection, I wouldn’t be prepared to have to deal with those…’ (P3); ‘Probably a little less motivated…’ (P5). | |
| Emotion | Screening would add some level of stress to my current workload. | 13 (100) | ‘Yes. It would add to the workload’ (P1). ‘Uh, probably, probably not too much, I’d probably be okay, if it was an easy protocol’ (P2). |
| Beliefs about Consequences | This trial could benefit my patients. | 12 (92) | ‘… Even if this didn’t work, at least stroke survivors are aware that we’re still always looking out for ways to help them recover, improve their independence. I think that’s a very strong, positive message for people. And then if (it’s) something that works out, that just becomes part of usual care down the line…’ (P3). ‘I would hope there would be symptom reduction. I think there’s probably enough evidence that there’s a chance we might [see] symptom reduction and we might see some signs of improvement…’ (P9). |
| There may be no benefit/ disadvantages for my patients. | 8 (62) | ‘… It may be a bit of a bit challenging for people who want to be really involved but aren’t the right person’ (P3). ‘For the patients, if they start having problems like transmission of infection, or problems with cell-based tumors which are a potential, umm you know if you get infusion reactions - those are all not necessarily good things’ (P5). | |
| The trial will be beneficial to me (my career, knowledge, personal achievements/ fulfilment). | 12 (92) | ‘Well, I think for myself, I think engaging in (an) advanced clinical trial would promote our skills, knowledge for the future of stroke care guidelines, promote academic involvement, promote our site to become a center of excellent, promote research activity’ (P4). ‘… Of course I will be happy to be involved in the writing process and research and be one of the main investigators and hopefully having publications and being involved in the scientific community. That would be my award, basically’ (P11). | |
| This will not benefit me, or there may be disadvantages. | 5 (38) | ‘And the fact that disadvantages may result in a negative trial. If it’s a negative trial the time isn’t necessarily well spent’ (P9). ‘… there are no immediate benefits – no extra pay and no extra time. You have to squeeze extra time from an already full, fully occupied pie’ (P4). | |
| Safety is important. | 8 (62) | (What about the most important factor for you agreeing to participate and screen as a whole?) ‘Oh uhh probably the safety profile of the stem cells – if I perceive that this is grossly unsafe I’m not likely to screen’ (P5). | |
| I am unsure of the consequences. | 7 (54) | ‘So we really have to know if there are going to be unperceived side effects that we’re not aware of at this point at this point possible. Will it work or not work, I think it’s still an unanswered question’ (P10). | |
| Beliefs about Capabilities | I do feel confident in my ability to screen/refer patients for this trial. | 11 (85) | ‘I’ve been doing clinical research for a long time so I’m pretty confident I can do it’ (P5). ‘As confident as the tool that you pick for me. If it has inter-rater reliability, then quite confident’ (P6). |
| I do feel confident in my ability to perform functional outcome measures. | 7 (54) | ‘I am very comfortable; I know all the scales…if it’s early stage I would say yes’ (P4). ‘Certainly, I feel comfortable doing functional outcome measures. (AC: So you do?) Sure’ (P8). | |
| Stress/workload may affect my ability to participate in the trial. | 3 (23) | (If it were to add stress to your current work load, how do you think that might influence your decision to screen for it? Would it make you more reluctant to do it?) ‘Yeah. If I looked at something and was like ‘Oh gosh, there’s no way that I can fit that in’, it certainly would, yeah’ (P8). | |
| Stress/workload would not affect my ability to participate in the trial. | 4 (31) | ’I wouldn’t just ignore the protocol and be like ‘ah sorry I just don’t have time to do that today’’ (P2). ‘Happy to do it if it doesn’t really interfere with what I'm doing now. If it’s nothing exceptional and I can just fit people as a part of my usual day-to-day scheduling then I don’t see it as a problem…’ (P3). | |
| Goals | I have other priorities than participating in this trial. | 10 (77) | ‘So it’s not the bottom of the heap it’s just if someone gets sick or if you’re not sure if they’re reluctant, if they don’t want to be screened, then obviously I wouldn’t try to convince them. I do think it’s important so I would not rank it right at the bottom’ (P2). ‘Well there are definitely going to be times when other things are more priorities for the patients. In the clinic, you might have other things that you’re doing so obviously if you get through your clinic, I don’t know how often that would happen. But if I was given the criteria and I saw a patient who was appropriate, I think that would be okay. In a busy clinic, that might be a challenge sometimes’ (P12). |
| Screening would be a top priority. | 1 (8) | ‘For patients that meet inclusion and exclusion criteria, I can’t see that there would be a lot else that would be a higher priority’ (P9). | |
| Behavioural Regulation | I would use a reminder/ a reminder would be helpful. | 9 (69) | ‘…a reminder around my clinic or having an email sent to me from the research coordinator, or if they were [to] come right to my clinic and say ‘Do you have any participants for the study today?’’ (P8). ‘Again, if there’s something, like a cue on the patients’ chart…’ (P13). |
| I would be able to manage my time and plan ahead. | 7 (54) | ‘Of course we always try to balance the clinical with the research, so we don’t want 50 studies that we’re supposed to be screening for and all that’ (P2). ‘Oh, I would just have to have a schedule’ (P7). | |
| Optimism | I would expect/hope for more good things than bad things. | 9 (69) | ‘I believe a lot of good things should come from that. For example, maximized patients’ recovery and neuroplasticity, implement treatment at (a) very early stage besides thrombectomy, enhances patient recoveries, I really believe that’ (P4). |
| Knowledge | I am aware/ have some knowledge of what ‘MSCs’ or ‘stem cells’ are. | 12 (92) | ‘In general, I am aware that they are potentially a therapeutic treatment…’ (P10). |
| I have limited knowledge of ‘MSCs’. | 1 (8) | ‘I don’t know anything about it’ (P7). | |
| I would require more information. | 7 (54) | ‘It would really come down to having more information about the treatment, what the plan was, who else is involved, what the risks and benefits were…’ (P8). | |
| Social/Professional Role and Identity | Certain aspects of screening could be a part of my professional role. | 10 (77) | ‘I would say potentially it could be, depending what it would entail, the timing. Sort of what the procedure would be, who’s involved, I can see it potentially being something that could be able to do here because I’ve been involved in clinical studies in the past’ (P8). |
| It is my role to refer patients. | 5 (38) | ‘… I do see part of my role as (patients) come through clinics or my colleague’s clinics, I would point them to a research coordinator to get them to consent to the study. I’m more like air traffic control (laughs). Of course I cannot consent them because I’m an investigator, but if I wasn’t an investigator in the trial the(n) I certainly could…but directing them to the right person for (the) informed consent procedure…’ (P5). | |
| Involvement in the trial would align with my role as a clinician/researcher at an academic institution | 7 (54) | ‘I think that part of my role is looking for treatment options…’ (P10). ‘Yep. Well I’m also a clinician scientist. So it’s part of my job, for sure’ (P12). | |
| It is not my role to screen patients because of a conflict of interest. | 2 (15) | ‘Ethical reasons – I don’t want to have the patient feeling pressure because I’m the attending physician and they feel bad’ (P4). | |
| It is not my role to perform functional outcome tests as part of a follow-up appointment. | 1 (8) | ‘I don’t think I would be doing that, if it’s someone else’s study I would probably ask them to do it. Depends on what it was, but you know if I’m not involved in the study then I would suspect that the researcher should be doing that kind of stuff’ (P2). | |
| Social Influences | The opinions of colleagues and other physicians/ researchers could have an impact on my decision to participate. | 8 (62) | ‘Well if we’re recruiting here then it would be nurse manager, the unit manager, inpatient/outpatient manager, anyone else it would impact I would imagine’ (P2). ‘Well, I would probably be interested to know if physiatrists that are doing stroke across Canada, how any of them are interested…’ (P3). ‘I think the patient’s care provider could be useful…’ (P13). |
| The people running the trial will have an impact on my decision to participate. | 3 (23) | ‘The most important factor would be whoever’s running the trial’ (P9). | |
| Memory, Attention and Decision Processes | I may forget about screening for this trial. | 6 (46) | Do you think it is likely that you might sometimes forget to screen for this trial? ‘It might happen, yeah’ (P12); ‘That’s a very common phenomenon’ (P9). |
| I do not think it's likely that I will forget to screen. | 5 (38) | ‘No, that’s not me. For any trial either I am PI or co-PI and if I commit to this task then I remember’ (P4). ‘I don’t think so. It certainly hasn’t been an issue in the past. But sometimes you do have a busy clinic and you get through and you’re ‘oh I should ask them about this study’. Usually it hasn’t been an issue in the past, I don’t think it’s very likely’ (P8). | |
| Skills | I have performed functional outcome tests in the past. | 6 (46) | Have you ever performed functional outcome tests? (eg, National Institutes of Health Stroke Scale/Score (NIHSS), modified Rankin Scale (mRS), Barthel Index (BI), Activities of Daily Living (ADL)) ‘Yes’ (P7). |
| I have not performed stroke functional outcome tests in the past. | 3 (23) | Have you ever performed any functional outcome tests? ‘No’ (P2). |
MSCs, mesenchymal stem cells.