Table 4.

Summary of themes derived from the qualitative analysis

Theme	Summary
1. Limited motivation to use tools designed to support patients participate in decisions	Low motivation for the intended role of patient decision was encountered, as illustrated by uncertain deployment of the tools in clinical pathways and low uptake by patients
2. ‘We already do shared decision-making’	Strong perception that clinicians were already involving patients in decisions, therefore no perceived need to change or to adopt decision support by adapting pathways
3. Perceived patients’ barriers to involvement in decision-making	Clinicians cited barriers such as technical access problems and often saw patients as those that did not want to be involved in shared decision-making or as those they felt had already accessed information on the internet
4. Organisational factors that reduce professionals’ motivation to involve patients in decision-making	External efficiency targets and health professionals’ views about the imperative of using effective treatments were significant barriers to introducing patient decision support tools