Table 3.

Themes and Subthemes Organized by Research Question

Themes	Subthemes	Representative Statements
Question 1: Why did music therapists choose to participate in the SMART II trial?
Theme 1: Opportunity to develop advanced skills in research.		“I was excited to have this be my first real hands-on research opportunity and to “get my feet wet”…”
Theme 2: Working in a team environment provides opportunities to advance research in a way that overcomes challenges associated with conducting research alone.	2.1. Working in teams provides greater feasibility for full-time clinicians.	“…it was nice to be able to get on board an established study as it is difficult/time consuming to create your own research project while working full-time clinically.”
	2.2. Benefit from collaboration with experienced researchers and an interdisciplinary perspective.	“I was attempting to get involved with research at my facility but found it overwhelming and time consuming. The way the SMART is set up and the accountability of the team to make it a success is the gold standard.”
	2.3. Recognizing additional ways to leverage personal and institutional resources.	“…knowing what I know now with the SMART study experiences, I feel better equipped to find the resources for research.”
Theme 3: Opportunity to advance music therapy research, and increase awareness and utilization of music therapy services.		“I was excited about the opportunity to contribute to a research project that was clinically relevant to music therapists, and that would also play a role in advancing the field.”
Question 2: What are the perceived challenges and benefits of delivering an intervention with a set protocol?
Theme 1: Initial challenge: Understanding what it means to work within a protocol.	1.1. Initial concern that the protocol would be confining for the therapist and patient.	“At first, I was afraid of being flexible and “in the moment,” and was initially scared of going into “robot” mode—only delivering exactly what I was supposed to deliver…I worried that …the protocol would become a barrier between me and the patient.”
	1.2. As familiarity with protocol increases, you become less scripted and more comfortable tailoring the intervention based on patient need.	“I found that with more experience (and time), I could easily stay within the protocol and bring my own personality into the mix.”
Theme 2: Ongoing challenge: Integrating roles as researcher and clinician.	2.1 Reconciling study vs. institution patient load.	“I find some patients who are coping very well engaged in SMART. If I met them outside of the study and assessed they were coping well with resources, I would not necessarily embark on a project this time intensive…”
	2.2. Scheduling time to complete study responsibilities is challenging especially for contracted music therapists.	“It is more difficult for MTs who do not work full-time to accommodate the patients’ schedules at all times.”
	2.3. Clinical trials require intervention fidelity that can limit therapists’ ability to modify the study intervention or introduce new interventions.	“The challenge has been to stay within the protocol …while we have some flexibility with this,…there is not the same leeway that would be present if the patient was not on a study.”
	2.4. Communication within and across sites to ensure coordination and timely delivery of study activities requires an active commitment.	“Early on we had a few hurdles to cross regarding communication, but we worked on that together and found a way to share information that was more effective for all of us.”
Theme 3: Benefits: Refines treatment and service delivery.	3.1. Using a protocol rooted in theory provides a framework the therapist can use to deliver individualized and effective care that benefits patients.	“Once the process/protocol is learned, then I can relax and enjoy the work with the patient and keep the focus on the patient’s needs/concerns/issues, instead of being concerned about my “performance.”
	3.2. Opportunities to work within a protocol and learn new intervention techniques, including ways to integrate technology into practice.	“The most appealing is getting to learn new techniques and integrate technology into practice.”
	3.3. Study provided infrastructure that allowed for increased visibility and integration of music therapy services within the healthcare setting.	“I have had a chance to build relationships with the nurse practitioners and Hem/Onc researchers, which has helped my working relationship with other departments.” (Therapist 2)
	3.4. Supportive relationships were cultivated from working and learning together with other therapists.	“It was great having other MTs working on the SMART II study here as support systems as I moved through the interventions with participants…”
Question 3. What are therapists’ experiences of self and external quality assurance monitoring?
Theme 1: Quality assurance monitoring provides protocol accountability.	1.1. External and Self-monitoring provides validation, affirmation, and alleviates self-doubt related to protocol delivery.	“…it is helpful to me as an intervener to sometimes show the difference between what I think I did in the session and what I actually did. The feedback from QA monitors has always been welcomed. Having a third party’s reflections allows me to think outside my own process, and it is nice sometimes just to have that affirmation that I’m on the right track.”
	1.2. External monitoring helps clarify and refine protocol delivery through collaborative brainstorming.	“For example, one patient I worked with had a hard time coming up with lyrics, and the QA monitor was able to suggest some brainstorming strategies that I hadn’t tried yet.”
	1.3. Self-monitoring is valued but can be time consuming.	“It is a great tool, and I learned a lot about myself after listening to sessions. However, it does take up quite a bit of time in the work day.”
Theme 2: Quality assurance monitoring provides professional development.	2.1. Self-monitoring process validates strengths and helps identify areas for growth	“I often walk away from my study interactions thinking, “that did not go well” or “I don’t think I delivered as a therapist,’ sometimes doubting my abilities; however, after listening back, it was often the exact opposite, and I was surprised with what I and the patient actually did accomplish.”
	2.2. Self-monitoring increases self-awareness (tendencies, patterns as a clinician) and improves practice skills	“Listening back to my own recordings has helped me to notice everything from words/phrases I may overuse to how my voice actually sounds, to things that went well during the session.”
	2.3. External monitoring provides helpful advice and strategies for growth; a different perspective	“Receiving feedback from monitors has been very helpful not only for quality assurance but for professional development.”
	2.4. External monitor provides valued professional feedback/support not normally available in work environment	“As clinicians, we don’t always have the opportunity to receive feedback from other MTs, so it was nice to hear that feedback about our works as well as being able to ask questions of others about either our performance or protocol.”
Question 4: What are therapists’ perspectives about their professional growth as a result on participating in a controlled trial study?
Theme 1: Able to identify areas for professional growth through experiences not often available in the workplace.	1.1. Quality Assurance Self-Monitoring provided opportunities for self-evaluation and reflection.	“There are a lot of barriers to recording sessions at my regular job (in a psychiatric hospital), so participating in the study has allowed me to engage in a level of self-analysis that I probably would not have done otherwise.”
	1.2. Group Music Therapist calls provided peer support and opportunities to learn from other clinicians.	“Being connected to a group of music therapists working on the study has been stimulating, and I’ve learned from the strategies that others have shared.”
Theme 2: Enhanced clinical knowledge and skills.	2.1. Increased knowledge about adolescents/young adults, family dynamics, and oncology.	“I feel that I’ve learned a lot about this population of kids/AYAs. This isn’t an area that I usually work in during my normal MT hours here, so I was happy to get to know this population a little more.”
	2.2. Enhanced skills in therapeutic songwriting, technology use, and song repertoire.	“I think the study has led me to become more comfortable with using technology such as Garage Band and iMovie, so I’m more likely to use these programs during my session.”
	2.3. Sharpened clinical documentation and communication to foster supportive relationships with patients, families, and staff.	“I feel that this process has helped me sharpen my communication skills, both with staff, families, patients, but also in written form (patient charts, assessments, emails, etc.) and increasing my ability to report objectively on my interactions with patients.”
Theme 3: Encouraged critical thinking about interventions, research, and significance of clinical work.	3.1. Examination of own MT practice and its application.	“…participation in the study has helped me to use a more critical eye when looking at my interventions.”
	3.2. Reading research critically and applying it to practice.	“It has renewed my interest in research, and I have applied to be a part of an Evidence Based Scholars group that meets to analyze and synthesize research literature to answer questions that come in from various groups/departments in the hospital.”
	3.3. Transferring knowledge and skills learned to work with other patient populations.	“There is a lot that doesn’t translate directly. But I think I am more likely to use songwriting in my groups now.”
Theme 4: Inspired interest in research and pursuit of additional research experiences.	4.1. Opportunity to participate in research presentations and dissemination.	“I have learned so much about the hospital setting, [medical condition], and research. This has lit a spark within me to pursue more opportunities in these areas.”
	4.2. Pursuit of advanced studies and training.	“I started a PhD in Expressive Therapy at Lesley University last fall, and am excited about the possibility of contributing more to the growing research base supporting music therapy in the future.”
Question 5. What are your thoughts on the value of research in music therapy from an interventionist’s perspectives?
Theme 1: Research evidence is necessary to advance the profession and is an integral part of music therapy advocacy.		“Music therapy must continue to pursue this [research] if we are to keep moving forward, especially in today’s healthcare environments.”
Theme 2: Research helps music therapists provide the best possible care by enhancing quality and consistency of care.		“Measuring the effect of different interventions and communicating those findings can help ensure that therapists are using effective practices that have been thoughtfully developed and tested, thus providing the best possible care to their clients.”
Theme 3: Opportunities to work as a study team member help de-mystify research and increase awareness about the value of research partnerships.		“…it takes a village to complete a research study, and although I don’t feel my talents lie in writing, and investigating and detailing of data, I do feel comfortable in the role of MT intervener, and am so happy to have been able to contribute to this important mission.”
Theme 4: Expanding professional network within and outside the music therapy profession helps increase awareness and uptake of research.		“In doing research, you also have opportunities to expand your professional network.”
Question 6. What advice would you give to clinicians who are deciding whether to involve themselves in research at the workplace?
Theme 1: Learn what participation will require. Conducting research is time consuming and requires skills beyond intervention delivery.		“I’d say first go into it with “eyes wide open”—learn about all the pieces that are required so you don’t get yourself in over your head to begin with, especially time-wise.”
Theme 2: Collaboration, communication and support are essential to success.		“Collaborate with others—there are so many opportunities for our profession to do this with other professions and doing something in a team allows for the full use of the diversity of the skills sets of the individuals.”
Theme 3: Seek out and use available opportunities and resources.		“…use all the available resources you have. In larger settings, there are often departments that are waiting to help with different parts of the process, and hopefully most are not going to look down on you if you don’t have all the knowledge or answers already. In my setting, most of the time those folks are just happy that someone really has an interest in research to start seeking out more information.”
Theme 4: Participation in research promotes professional development and can “reap big rewards” for the clinician and profession.		“Involvement in research is a big commitment but can also help reap big rewards for the clinician’s work and the profession.”