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Table 2 Potential facilitators to prescribing and setting individualized dialysate temperatures (IDTs) (n = 18)

From: Barriers and facilitators to healthcare professional behaviour change in clinical trials using the Theoretical Domains Framework: a case study of a trial of individualized temperature-reduced haemodialysis

Theme

Sub-theme

Belief statement

Frequency (out of 18)

Theoretical Domains Framework, domain(s)

Theme 1: awareness of clinical guidelines and how IDT fits with local policies

Awareness of need for more evidence

- It needs to be studied

18

Knowledge

Awareness of evidence

- An intervention that’s been studied for which there’s reasonable evidence of benefit

10

Awareness of guidelines

- There are guidelines for dialysis treatment

7

Link with existing policies

- Individualized cooler dialysate temperatures will not conflict with local policies

12

Goals

Centres have existing temperature standards

- Centre standard is 36.5 or higher

10

Knowledge/Goals

- Centre standard is less than 36.5

6

Theme 2: benefits and motivation to use IDT

Positive clinical management consequences

- Cooler dialysate temperatures can help manage or prevent hypotension during dialysis

17

Beliefs about Consequences

- Cooler dialysate temperatures can help with fluid removal during dialysis

7

Positive potential long-term consequences

- Individualized cooler dialysate temperature may lead to better cardiovascular outcomes

8

Beliefs about Consequences

- Individualized cooler dialysate temperatures may lead to a reduction in morbidity and mortality or increase longevity

3

- Individualized cooler dialysate temperatures may preserve cognitive function

2

Optimistic

- Based on what I'm hearing, I'm quite optimistic

16

Optimism

Patient benefit is inherently reinforcing

- If you can prevent symptomatic hypotension for your patients, that’s rewarding

11

Reinforcement

Priority

Setting/prescribing IDTs is a priority because we need to know the answer

7

Goals

Theme 3: IDT alignment with usual prescribing and setting practices and roles

Procedures and roles specific to physicians

- The physician would order or prescribe individualized cooler dialysate temperatures

14

Social Professional Role and Identity/Nature of the Behaviour/Beliefs about Capabilities

- Physicians are responsible for prescribing dialysate temperatures

11

- Prescriptions are applicable over all treatments until changed again

8

- I would have to be able to prescribe IDTs in a way that I wouldn't have to review every treatment because that would not work

5

Procedures and roles specific to nurses

- We usually measure core body temperature before and after treatment

8

Social Professional Role and Identity/Nature of the Behaviour/Beliefs about Capabilities

- Nurses can modify dialysate temperature during treatment

5

- Dialysate temperature is set automatically or is a default

5

- We usually accept treatment parameters

3

Influences among health care professionals

- Nurses follow the doctor's orders or prescription

12

Social Professional Role and Identity/Nature of the Behaviour/Beliefs about Capabilities

- Nurses influence physicians when prescribing dialysate temperature

10

It will be easy to prescribe or set IDTs

- I am confident that I will be able to prescribe IDTs for all my patients

10

Beliefs about Capabilities

- It will be easy to set individualized cooler dialysate temperatures

8

- It will be easy to prescribed IDTs

8

Theme 4: thermometer availability/accuracy and dialysis machine characteristics

Dialysis machine can be adjusted in 0.5 or 0.1 increments up to 35 Celsius

- Can adjust dialysate temperature by 0.1 increments

3

Environmental Context and Resources

Theme 5: Impact on workload

Impact on workload

- My workload will increase minimally

10

Beliefs about Capabilities/Beliefs about Consequences

- Reducing episodes of hypotension during dialysis can decrease workload

7

- My workload will not increase

6

Theme 6: patient comfort

Tolerability

- Patients are not likely to notice the cooler temperature/not likely to be side effects/generally well-tolerated

8

Beliefs about Consequences

Coping plans for patients who say they are cold

- We give blankets to patients who feel cold on dialysis

12

Behavioural Regulation

- For patients who feel cold on dialysis, we suggest that they wear warm clothing and bring blankets

5

No emotion related to IDTs

- I don’t or I won’t have any emotions related to dialysate temperature

6

Emotion

Theme 7: forgetting to prescribe or set IDT

Unlikely to forget

- I won’t forget

7

Memory, attention and decision making