Table 2.

Supporting quotations for Molecular Diagnostic Concerns theme

Subtheme	Supporting quotations
Unfamiliarity with molecular diagnostic test capabilities	12. I need to know about the device, I think. What can it detect, in what populations has it been used, how confident can I be? We all know that I’ve got a fairly poor set of clinical tools for defining respiratory infection at the moment. But it’s before I’m going to start interpreting another one I need to know a bit more about that. –P48, consultant, Hospital 1
	13. I’m not familiar with this machine; I’ve survived 30 years without having one. […] because I just don’t have a feel for the machine, I’d have to try it out for a bit and see what the results are. We have to try and use evidence based, don’t we? I’d be reassured if I knew that either it worked really, really well or, on the other hand, that it didn’t. –P36, consultant, Hospital 2
	14. Products come in and tests come in and it doesn’t necessarily change what we’re actually doing on a day to day until we’ve seen it work a few times. –P58, middle-grade trainee, Hospital 1
Molecular diagnostics detecting non-pathogenic bacteria may lead to over-treatment	15. […] how convinced would I be that it’s [molecular test] picking up a pathogen rather than just an incidental coloniser. I’m not sure it would change what I’d do. –P6, consultant, Hospital 3
	16. […] there’s no test which is 100% specific, and there’s no test which is 100% sensitive. So yes, I’m thinking whether this [test] would lead to over-prescribing of antibiotics that might lead to an increase in drug resistance […] That’s why it’s very important to know how sensitive and specific the PCR is. There are a lot of commensals in our respiratory tract. –P31, middle-grade trainee, Hospital 2
	17. […] whether that [positive result] is a colonisation rather than infection it would still be the same decision-making processes. So new temperature, a change in the inflammatory markers, a change in the secretion burden. –P45, consultant, Hospital 1
Molecular diagnostics failing to detect pathogens may lead to under-treatment	18. […] if I’ve growna nothing I’m not sure whether that would be depending on the sensitivities or whether that’d be reassuring enough to not cover the chest and just cover the abdomen. –P58, middle-grade trainee, Hospital 1
	19. If she [vignette patient] didn’t bring up anything [i.e., negative result], but we still suspected a chest infection, or the X-ray showed something, then we would start [antibiotics]. –P2, early-career trainee, Hospital 4
Concern of patient deterioration while awaiting molecular diagnostic results	20. […] six hours doesn’t seem that long. But that could have a detrimental effect because six hours could be too long for this patient. –P24, early-career trainee, Hospital 1
	21. If I thought it [molecular results] was something that was very convincing and she [vignette patient] was quite stable and I could wait two hours, then yes, potentially. But it doesn’t sound like you’re portraying a stable case; you’re portraying someone that has come from a local unit looking like a bronchiolitis, getting worse, needing intubating. –P54, middle-grade trainee, Hospital 2
	22. I don't think you could justify waiting six hours to treat someone if they’ve got overt signs of sepsis. –P21, middle-grade trainee, Hospital 3
	23. I wouldn’t start [antibiotics], I would wait a few hours because if I know in a couple of hours I’d have a result and she’s [vignette patient] not in shock and not very bad I would wait to see if something comes up positive. –P23, middle-grade trainee, Hospital 2
	24. Because if you knew what the answer would be within six hours, and given that she’s [vignette patient] not systemically unwell at the moment, I would be more comfortable holding off [antibiotics]. –P47, early-career trainee, Hospital 4

PCR polymerase chain reaction

^aThis is a misapprehension; the device does not ‘grow’