Table 3.

Theme 1: Roles in decision making and decision aid use.

Theme	Subtheme	Patient interview quotes	Clinician interview quotes	Video observations
Clinician Roles	Clinician as expert	P34: “Yes [it was the] first time ever [that we talked about a statin and used a DAJ. [… J To be real honest, the only thing I was interested in was what my medical professional had to say, and how it was presented was irrelevant.”	C14: [Regarding effectiveness as shown on the diabetes DAJ: “They would look at this and say, ‘Well, none of these drugs really work.’ One or two percent, but, you know, you sort of have to explain what that means in relationship to their hemoglobin A1c.	Diabetes DA Case 1: Clinician quickly reads off current lab results and provides patient with a lot of information about what medications do, their side effects, which lab numbers are good or not, and revisits old lab results. The patient occasionally asks questions but mostly listens.
		P41: “I had not heard about [medication DAs J but you know […] I am not up to date on all that stuff anyway, I rely on the doctor. I figure that’s his line of expertise.”	C08: “I do see it as my role […] to teach them and allow them to make the best decision on their own […] But the other side of it, as a physician, you’re […] responsible for them even if they make bad choices.”
	Clinician as authority figure	PI 62: “[…] I think of [my clinician’s] concern and I want to please him. I mean I got to please myself. It’s nice to have him acknowledge ‘Hey, I’m seeing less of you these days,’ you know.”	C06: “I would say a good majority of the patients just say ‘You’re the doctor, just tell me what you want.’” C08: “I think there is a bit of feeling of maternal responsibility […] This is going to sound really bad, but in spite of their resistance to something, you know, you have a responsibility of pushing them.”	Control Case 2: Clinician recommends increasing the dosage of the current medication: “You shouldn’t really notice anything… you double up that dose… take two a.m. and p.m.” There is no discussion around what other options exist to help reduce blood sugar. No options are presented.
	Clinician as advisor	P48: “[My clinician] never really tells me what to do, but […] he points me down in the direction and we discuss it.”	C08: “I think they all look to be given advice.”	Diabetes DA Case 3: Clinician gives patient a card to look at and says insulin is an option. Patient says she does not want shots. Clinician talks about cost, routine, side effects, and low blood sugar risk. He says: “Which ones put you at risk of going too low?” But for “(medication name] is kind of what I’m aiming for, [low blood sugar] not an issue.”
		P49: “Based on my results [my doctor] said: T don’t recommend any changes. Keep on doing the same thing you’re doing. It’s working for you.’ […] He’s really good about that. He’s more like a coach.”	C07: “If I have a strong feeling one way or the other, that they ought to do one thing or another […] I might tell them ‘I really think you should do this, but this is up to you.’”
	Clinician as persuader	P34: “And it depends on, you know, if someone said, ‘Do you want to go on [medication name]?’ I would have said, ‘No,’ but my doctor laid it out in such a way that when he finished talking, I knew there was no choice. I was just going to go on a diet, and he said, ‘No, you need to do this,’ and he explained why so I did it.”	C17: “It was easy to direct patients with the cards, […] and it was easy to lead a patient down a path that agreed with what you thought might be their best choice.”	Statin DA Case 4: Clinician uses statin DA to explain the patient’s MI risk. He says: “Medicine is cheap. If it were me, I would take a statin” and statins are “well respected” and “very commonly used.” She does not ask about patient preferences. Patient agrees to start a statin.
Patient roles	Patients as drivers of their care	P52: “I’m a hundred percent responsible, number one. Two, the only other person that really has an interest in me […] is my wife […] and then my doctor is the sounding board.”	C13: “They should be the drivers of their healthcare. I think on a number of levels. One […] it’s their health, it’s just their right to be able to make decisions, and if you are going to make a decision, you need good information to make it with.”	Statin DA Case 5: Patient has lost 20 pounds. Clinician congratulates him. They review progress on cholesterol and blood sugar. Clinician: “These are some great changes.” Patient: “So technically, I am not diabetic anymore, am I?” Clinician: “[…] You’re controlled, yeah.” Patient says [medication] has helped. Clinician then reviews statin DA. Patient notes that losing weight will help prevent an MI too, and doesn’t want a statin: “You know if I come back here three months from now and the tests look different, then you know, but I […] don’t want to start down these pill roads.”
	Patients as learners	P48: “I have a spreadsheet that I keep track of all my […] blood results and everything. […] I try and track my weight. I always jot down my blood pressure and my pulse, and I keep track of the blood tests.”	C13: “With diabetes we’re trying to get their A1c’s to a certain target and their LDL to a certain target and some patients buy into that. You know, the engineer who comes in with three colored pens and the graphs laid out in a spread sheet. They get the numbers and they’re excited about that.”	Control Case 6: Patient has lost weight. Clinician praises her and asks what she did. Patient says she watches carbohydrates. Clinician mentions that while A1c is lower, it is not low enough to stop her medication. Patient says she intends to continue exercise and hopes to then drop one of her 3 medications. Clinician says that it is possible.
	Patients as partners	P048: “We concluded this time let’s give the diet and exercise a crack, let’s give the weight loss, let’s try some weight loss until we start messing with that. And [the clinician] talked, and he said ‘You know, there’s a lot of different options still.’”	C07: “Those DAs […] are helpful a lot of times… So, if you can get the patient on board with what you’re doing, it’s always helpful […], you get more cooperation.”	Diabetes DA Case 7: Clinician suggests beginning a medication; he fans out [DAJ cards at arm’s length from patient and asks which card they should look at. Patient has no preference. Clinician takes A1c card: “I don’t think an oral medication [is] going to do the job,” and suggests insulin. He uses cost card, says some oral medications are “awfully darned expensive.” Patient does not want to do “the shot thing,” and asks about side effects. They discuss, and agree to try an oral medication before insulin.

DA, decision aid; SDM, shared decision making; LDL, low density lipoprotein; MI, myocardial infarction. A1c, hemoglobin A1c/glycosylated hemoglobin. Brackets in quotes ([…]) refer to deleted disfluencies (e.g., “um”), repetitions, or tangential phrases (for brevity); inserted text (for context/clarification); or non-verbal cues (e.g., [chuckles]).