Table 3.

Additional representative quotes from patients and providers identified during two-phase qualitative analysis

MPT Interval	Inductive Theme	Quote
Appraisal	Nonspecific symptoms	“Mild abdominal pain, changes in bowel movements, nausea, change in the size of the abdomen without frank distention, sometimes pulmonary symptoms if someone has malignant ascites, urinary symptoms, early satiety ... a broad range of often vague and nonspecific symptoms.” (Provider 1, Internist)
Appraisal	Nonspecific symptoms	“Ovarian cancer is obviously one of those things where symptoms are not very reliable, as is true for most cancers.” (Provider 3, Gastroenterologist)
Appraisal	Nonspecific symptoms; Management and normalization of symptoms; Perception of underlying health	“... and the bloating and stuff ... I really thought two things were going on. I thought I was having some menopausal issues even though I had had a hysterectomy ... I’d been doing hormone replacement therapy with estradiol and low-dose testosterone, but I wasn’t doing progesterone, so I thought maybe these were just symptoms of menopause because I’m, you know, older.” (Patient 5, Age 55, Stage IV)
Appraisal	Nonspecific symptoms; Management and normalization of symptoms	“I was mostly just tired and achy, and you could be tired and achy for a billion different reasons.” (Patient 13, Age 29, Stage III)
Appraisal	Management and normalization of symptoms; Perception of underlying health	“I never would have thought of ovarian cancer. I never would have thought of cancer. I just thought for sure I was never getting cancer ‘cause I was too healthy. My lifestyle was everything about not cancer. I did water fasting. I ate a clean diet--it was ketogenic half the time.” (Patient 5, Age 55, Stage IV)
Appraisal	Management and normalization of symptoms	“I would eat yogurt to calm my intestines.” (Patient 4, Age 64, Stage IV)
Appraisal	Perception of underlying health	“I had just gone in for my yearly exam[s] … pap smear, the dermatologist, my eye exam. I was so on the ball.” (Patient 8, Age 48, Stage III)
Appraisal; Help-seeking	Avoidant coping strategy; Social support	“Sometimes when you probe the patients a little further, especially the ones that don’t want to come in ... they’ll say, ‘I knew something was wrong and I didn’t want to know’ or ‘my family member actually made me come in’.” (Provider 2, Oncologist)
Appraisal; Help-seeking	Avoidant coping strategy	“I remember looking up stomach pain, and it did say that’s one thing you should not discount…but I thought well, my biggest fear was tests. I didn’t want to have to go through tests, ‘cause they wouldn’t be able to diagnose my problem.” (Patient 6, Age 57, Stage I)
Appraisal; Help-seeking	Access to care	“I’m very cheap and that’s one of the reasons I didn’t go to the doctor’s, ‘cause I’m like, I don’t want to pay for this, you know, all these tests ‘cause I know tests are expensive.” (Patient 6, Age 57, Stage I)
Help-seeking	Worsening, extreme, or abnormal symptoms; Persistence in seeking care	“I texted [my PCP, a nurse practitioner,] and said that [the symptoms were] getting worse.” (Patient 15, Age 59, Stage III)
Help-seeking	Access to care	“I was due to see my midwife for my annual exam anyway, so I called her.” (Patient 2, Age 53, Stage II)
Help-seeking	Access to care	“Their medical literacy and I’m sure their education, as well as access to the internet, whether they can even look up their symptoms, I could go on for hours.” (Provider 6, Emergency Medicine)
Help-seeking	Access to care	“I think financial sometimes is an issue. They know it’s gonna cost them a lot of money and they don’t have insurance, or they don’t have good insurance. That is sometimes an obstacle we see.” (Provider 2, Oncologist)
Help-seeking; Diagnostic; Pre-treatment	Access to care	“… language, that probably overlaps to some degree with socioeconomic dimensions; insurance, I think in this country is a big deal.” (Provider 3, Gastroenterologist)
Diagnostic	Access to care	“Payer issues, healthcare literacy, or communication barriers might stall or prevent accurate diagnosis when someone is lost to follow-up or does not show up.” (Provider 1, Internist)
Diagnostic	Provider perception of patient risk	“In the cases we have found and confirmed [ovarian cancer], [the patient’s symptom] is most commonly a feeling of abdominal fullness or feeling like they have a mass. And I feel like there has been one case of abnormal uterine bleeding which we didn’t think related back to the end malignancy finding but was [the symptom] [the patient] came in for.” (Provider 9, Gynecologist)
Diagnostic	Features of complex diagnoses	“I had gone to an instacare and they were like, ‘your lungs sound fine, I don’t know, maybe it’s walking pneumonia’ and they put me on antibiotics.” (Patient 8, Age 48, Stage III)
Pre-treatment	Access to care; Social support	“I asked [my gynecologist], “what do I do now?” She said, “well you call [Huntsman Cancer Institute] ...She looked at me and asked, “do you want me to do it?” I said yeah. She ended up making two calls to Dr. [Name removed] to get me in and the next week I was in Huntsman.” (Patient 14, Age 72, Stage III)