Table 5.

Quotes Illustrative of Motivational Facilitators and Barriers

TDF Domains	Relevant Themes	Illustrative Quotes
Social/professional role & identity	Urologists and staff consider initiating trial conversation as their role while others also take part in the referring process.	Honestly it would have to start with the physicians because that’s where patients are going to get their initial information about a trial. But nurses are going to talk to patients and answer questions. We need to know what’s going on with trials as well. [Talking about trials] is really part of giving the patient their options and making them aware of all of their options including trials. That should first come from the physician.
	Urology staff see their role in offering clinical trials.	If I’m aware of a certain patient that’s great for this trial and maybe the doctors haven’t thought of it, that’s somebody that I’d bring up.
	Urologists see their role in following and co-managing patients on trial.	You’re still going to be seeing their CT scans after you took out their kidney, you’re still going to be seeing them in clinic.
	Urologists feel responsible for maintaining positive professional relationship with their patients after the referral	Of course, we can always refer patients on to whoever it is that has that information but sometimes if you’ve developed a relationship with a patient as a physician or as a nurse and they trust you to give them information and they want to get it from you, they don’t want to call someone they don’t know and ask them
Beliefs of consequences	Urologists with positive attitudes toward clinical trials were more likely to offer trials to their patients.	I like clinical trials, and I think they are how we advance medicine…so I’m probably biased towards trying to get people signed up. You don’t always have a good outcome for them (patients) and so I think it’s good to be able to give them options. he (a patient)’s not going to make it. It would just be neat to have something to offer him.
Emotion	Urologists’ emotion, mainly fear, influence their decision to offer trials.	I think nationwide there’s a perception that they’re going to lose the patient.if they sign up on a clinical trial… We’re all human, I don’t want to be embarrassed, so I don’t want to bring up a topic and not know all the answers about it. So that’s probably one of the things I’m probably a little reluctant to talk to them about clinical trials, because I don’t know how the randomization is going to go, and I can’t answer all their questions…

Other motivational determinants discussed included beliefs about capabilities, intentions, optimism, goal setting, and reinforcement.