Table 2:

Additional Selected Representative Quotes, by RE-AIM Domain and Subtheme

RE-AIM Domain	Subtheme	Representative Quote
Reach	Logistics	I think having hard copies for whatever resource material, for ICDs or not ICDs, just from general EP care, is probably what will work best for our clinic setup…I think having some sort of decision information tool or packet or thing in the patient room is helpful. S6P2-MD
		I think just having them [DA] physically there (improves reach). S5P3-MD
		I think location physically, because they’re right in front of you, and if you see them, I mean, I see them, like, I sit in this one spot for clinic, and I, like, see them right in front of me, so it’s, like, a good reminder. And I remember one time somebody, a patient left, and I was like, oh, I should have given it, so I grabbed one. S7P5-MD
	Uneven Uptake Among Clinicians	Yeah, I mean, we use it, but that being said, I mean, we don’t have like a ton of providers back here, but as far as I know, our electrophysiology group is using it and the rest of our general cardiology providers are using it as well. So, I’ve never asked them, but I was under the assumption that they were. S6P5-PA
Effectiveness	Decision Quality	Interviewer: You told us a bit about how you try to get the decision aids to people. Have you changed the way that you talk with patients or have you noticed a change in the conversation that you have with patients after you started using the packet? Interviewee: I think that maybe we try to maybe make it more towards them making a decision about it. S1P3-NP
		This [decision aid/study] has just really like opened the door to what the discussion should be, which is, “Here’s your potential for benefit. Here are the risks. Here’s your likelihood of benefit over four years. Here’s how many of people like you who get this procedure, get this device implanted actually derive benefit from the device during those four years. Here’s the number who don’t.” Then patients can make a better decision about it. S1P4-MD
		So what I would definitely say is, relative to before implementing the ideas of shared decision making in our practice more generally I do feel like we have more effective communication with patients. I definitely feel like I have a more mindful and concrete understanding of what patients want specifically. S2P1-MD
		My personal opinion is I think that folks are more sure of what they want. They feel like it either is the right thing for them or not. And I benefit from it because to me it’s important that they understand what the purpose of this is. And I’m always surprised by what – how different interpretations of what we said can be. Often when physicians, I think in particular, are saying something, they think, “Boy, I could not have said that any clearer.” And then you assess what people heard, and you’re kind of surprised. You’re like “Oh, that’s what you took out of what I said?” S2P2-MD
Implementation	External Environment	I think obviously the CMS mandate, the guidelines, and the mandate I think have made the process a little bit different. S6P1-MD
	Implementation Infrastructure	Our staff, meaning our medical assistants and schedulers, are instructed to provide them with materials for shared decision making so they get printed materials and they get a link to your website with the shared decision making videos…It’s been going pretty well. Ideally we’d be at 100 percent, but we’re not at 100 percent so we’re trying to figure out ways we can increase our reach to make sure that patients have reviewed everything before they show up. S3P1-MD
		the director of our group – (they’ve) been pretty proactive also about making sure that the right patients get included in the study. So, I think that’s been helpful, too, kind of coming from the top to make sure that we’re capturing all the patients we need to. S5P6-NP
	Intervention Characteristics	one is making them shorter. But the – I feel this way about informed consent forms, too. Anything over a page, you’ve probably lost your audience. I see by actually having one of these things be one page, or at most two, like a front and back because you can laminate it, reuse it. Post-COVID you can start reusing things again. There’s a simplicity to that one to two-page max that I think would be actually valuable. S7P1-MD
		how likely people are to respond by their different conditions or what may or may not be appropriate. Like if you have like in my opinion if you have an 80 year old nonischemic with a huge left bundle there’s good evidence that probably you do a CRT pacemaker. But a defibrillator may not be the right option. And sometimes people kind of struggle with that concept. S4P2-MD
		we’ve had a couple people comment about they love the videos and it really helped them. S4P1-MD
	Recipients/ Patients	I think before the packets are introduced in the clinics and inpatient settings, I think it needs to be presented at a provider meeting, just so everybody knows what’s out there and it’s not a surprise. Where we had not done that here, so it’s a constant upgrade to the attendings when they come into clinic. And so it’s sort of the fellows and the nursing staff know about it, but sometimes the attendings don’t. They haven’t been in clinic for a while. S6P4-RN
Maintenance	Perceived Effectiveness	this should just be part of the standard of care. S5PP3-MD

RE-AIM = Reach, Effectiveness, Adoption, Implementation, Maintenance; ICD=Implanted cardioverter defibrillator; EP=electrophysiologist/electrophysiology; DA=Decision aid; CMS=Centers for Medicare & Medicaid Services; MD=Physician; PA=physician assistant; RN=Registered nurse