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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