Table 2.

Exemplary Quotes of Patient-Centered Adaptations

Interviewee/Excerpt#	Quote
Theme 1.1: Language, Culture, Patient Experience
Excerpt #1 Pain Counselor-CRC#4	Medicina integral [integrative medicine] or medicina natural [natural medicine], yeah, and I'll mention it. I think in both cases I'll mention examples. Because even English speakers will say “Wait, what are you talking about?” When you say that's what that is.… No, so I'll say things like massage, acupuncture, acupressure, herbal medicine, and vitamins. And they are like “Oh, okay. I get what you're saying.”
Excerpt #2 Pain Counselor-CRC#3	If they ask me like, “Oh, I've seen that it's needles”, if they're nervous about it. I say, “I don't like to call them needles. I like to call them wires because they're really, really small and they're as thick as a strand of hair.” And I have the little chart that we printed out with a match and then a needle just to compare sizes. And then I say, “As far as pain goes, most of the insertion sites, you won't feel anything. From personal experience, I mostly don't feel anything but when I do, I'll feel like someone's tugging on a hair on my arm. So it's just very slight and momentary and then it goes away.”
Excerpt #3 Pain Counselor-CRC#4	#4: And they actually felt uncomfortable with some of the—which I think we went over afterward—because he's homeless, and so he doesn't necessarily have a safe place. So it was hard to imagine a safe place.
	Interviewer: Right. Was that before we switched the language?
	#4: Yeah, that was before.
Theme 1.2: Developing Trust
Excerpt #4 Pain Counselor-CRC#2	I think some of them might get surprised [that study acupuncturists are not Chinese]. I think I remember one patient were asking me, “Oh, so they don't speak Chinese? Then how do they study Chinese medicine?” So I told them, “Oh, there's schools that you can learn about it in English.” I don't know if it's because I'm introducing the acupuncturist all the time, and it's reassuring to have someone that looks like them to tell them that this person's legit… It's a trust issue.
Excerpt #5 Pain Counselor-CRC#4	I try to connect with them on that cultural level. So I came in, I talk about the same things, that I'm from the Osher Center we focus on natural medicine, but my form of delivery is different. I try to be a little more warm. And then they asked me where I'm from, that's a common thing for people who come from other countries I would say, or at least from Latin America and Central America in my experience. And so they'll ask where I'm from, and I mention I'm born here but that my mom is from [Latin American location], and my dad is from [Latin American location]. And then we'll talk a little bit about that. Maybe they're familiar or maybe they're from there. And so one of them, his wife actually has the same last name as me so we connected on that.
Theme 1.2.1: Building Trust in a Single Session
Excerpt #6 Acupuncturist #3	Learning how to choreograph our relationship ahead of time as much as possible is not really something that you can do in-patient. And so, creating that, I think that a big indicator of the success of that creation in the first 5 to 10 minutes is how many people literally just fall asleep. And if they were feeling anxious, they would not fall asleep. If they were feeling tremendous pain, they would not be able to sleep.
Excerpt #7 Acupuncturist #7	Like, I think it's not developing the relationship just because we don't have enough time. I mean, we're only seeing them once.… I think the minimizing interruptions and then the quiet time does seem to be a big piece of it. Although that's also separate from the intervention is just like a nice additive effect potentially.
Theme 1.3: Agency to Decline Treatment
Excerpt #8 Pain Counselor-CRC#3	I kind of stressed the fact that it is voluntary because I feel like just coming from a Latino background, it's easy to think, “Oh, someone's coming in. They know what's best for me. Or I should listen to what …” I just don't want them to … I know that feeling like in my grandparents for example. And so I always try to remind them, “This is voluntary.” Especially if they just don't want to say no because they don't want to be rude. But you can tell that they're just like, they don't want to do this. So then I just try to remind them, which I think that some of the English speaking patients, they're more willing to kind of stand up for themselves and be like, “No. I don't want to do this.” So that's kind of a difference, because I think that kind of happened with the second patient. He had just had different people, care providers, come in. And so by the time I came in, he's like, “I'm just so tired. I'm so … I just had like three meetings.” And I'm like, “That's fine. You don't have to talk to me.” You know?
Excerpt #9 Acupuncturist #1	They just change their mind, or they're not ready, or it's too much. There's just too much going on. So I'm like, “It's totally okay. You have every right to decline this.” So I just reinforce that it's fine to have autonomy in that. Because how many things here can they really say no to?