Table 2.

Grading of Recommendations Assessment, Development and Evaluation (GRADE) Confidence in the Evidence from Reviews of Qualitative Research (CERQual) evidence profile

Summary finding	Studies contributing substantially to the summary theme (studies numbered as per online supplemental appendix 3, table 2)	Methodological limitations	Coherence	Adequacy	Relevance	CERQual GRADE evidence	Explanation of CERQual assessment
HCPs experienced strong, internalised, often polarised and deeply personal basic emotions that were modulated by the HCP’s cultural and/or religious background. Level embedded: cultural/religious	1, 2, 3, 5, 13, 18, 19, 21, 24, 26, 28	Minor methodological limitations concerning location of the researcher theoretically/culturally, and influence of the researcher on the research and vice versa.	Moderate concerns regarding coherence.	Minor concerns regarding adequacy.	No or very minor concerns regarding relevance.	High	Variability in experiences of participants posed a challenge with respect to coherence; however, this also added to the richness of results. Hence, we have graded the confidence in quality of findings as high.
Influenced by the sociopolitical environment as well as the social discourse on suffering and death, HCPs’ shared emotions of personal growth/sense-making and relational experiences of deeper compassion and sympathy. HCPs also experienced emotional dissonance over personal emotions and emotions expressed to conform to legislative rules. Level embedded: Sociopolitical	2, 5, 6, 8, 11, 14, 23, 25, 28, 30, 32, 34	Moderate/minor methodological limitations concerning location of the researcher theoretically/culturally, and influence of the researcher on the research and vice versa.	No or very minor concerns regarding coherence.	No or very minor concerns regarding adequacy.	No or very minor concerns regarding relevance.	High	Paper 6 did not approach the ethics committee and hence does not have ethics committee approval. Apart from this study, all studies in this group contributed to the summary findings in terms of coherence, adequacy and relevance. Hence, we have graded the confidence in the quality of the findings to be high.
HCPs expressed emotions aligned with their individual professional values and belief systems and, most of the time, attempted to align their values associated with the MAiD ideology; at other times, legislation of respective jurisdictions helped shape emotional experiences. Level embedded: Professional/legal	3, 4, 5, 7, 9, 10, 12,15, 16, 17, 20, 22, 24, 27, 29, 31, 33, 35	Moderate methodological limitations concerning location of the researcher theoretically/culturally, and influence of the researcher on the research and vice versa. Also, selection of participants. Paper 16, one single hospital.	Minor concerns regarding coherence.	No or very minor concerns regarding adequacy.	No or very minor concerns regarding relevance.	Moderate	Most of the studies in this group had methodological problems of selection bias and lack of generalisability. For example, paper 16 selected participants from a single hospital-based setting. The findings are limited in terms of generalisability to similar groups in different settings. Hence, we have graded down our confidence in the quality of findings to moderate.