Domain 1: Research team and reflexivity
Personal Characteristics
1. Interviewer/facilitator	Shannon Golden, MA conducted the English interviews and focus groups. Aura Rosado, MSW conducted the Spanish interviews.
2. Credentials	Savithri Nageswaran and W. Adam Gower are physicians; Shannon Golden is a medical anthropologist; Nancy King is a bioethicist; and Aura Rosado is a social worker.
3. Occupation	Savithri Nageswaran, W. Adam Gower, and Nancy King are faculty in academic medical schools. Shannon Golden is a senior research associate. Aura Rosado is the care coordinator of the palliative care/complex care program.
4. Gender	Savithri Nageswaran, Nancy King, Shannon Golden, and Aura Rosado are cis-females. W. Adam Gower is cis-male.
5. Experience and training	Savithri Nageswaran has experience conducting qualitative studies. Shannon Golden has extensive experience in qualitative data collection, analysis, and reporting. W. Adam Gower and Nancy King have subject matter expertise. Aura Rosado has prior experience interviewing Spanish-speaking caregivers of children with medical complexity.
Relationship with participants
6. Relationship established	Shannon Golden has conducted interviews of 3 caregivers of 3 children for a previous qualitative study. Aura Rosado provided care coordination services for 3 of the 6 children whose caregivers she interviewed. Shannon Golden did not have relationships with participants of the focus groups.
7. Participant knowledge of the interviewer and focus group facilitator	The research was explained to the participants prior to the interview and focus group as part of the informed consent process.
8. Interviewer and focus group facilitator characteristic	Interviewer and focus group facilitator characteristics are described above.
Domain 2: Study Design
Theoretical Framework
9. Methodological orientation and Theory	The paper has a phenomenological orientation and an analysis process consistent with thematic content analysis.2
Participant selection
10. Sampling	All children were identified as having had a tracheostomy from 3 sources: 1) i2b2 query of hospital administrative database, 2) a list maintained by the otorhinolaryngology department, and 3) children referred to the palliative care/complex care program. Only children meeting the inclusion criteria were included in the final sample. Healthcare providers were identified by their specialties within the pediatric hospital.
11. Method of approach	Potential participants for interviews were recruited by telephone contact. Focus group participants were recruited by email or in-person.
12. Sample size	56 caregivers of 41 children participated in the interviews. 33 healthcare providers participated in 5 focus groups.
13. Non-participation	8 caregivers of 8 children with medical complexity did not participate. Of these, 6 refused to be interviewed for various reasons, and 2 cancelled scheduled interviews. We did not calculate non-participation for focus groups.
Setting
14. Setting of data collection	Of the 41 interviews, 33 were conducted in the homes of children, 5 in the hospital; 1 in parent’s office and 2 in restaurants. All focus groups were held at conference rooms in the children’s hospital.
15. Presence of non-participants	Children were present in most interviews, but did not participate in the interviews. A notetaker assisted with all focus groups.
16. Description of sample	Sample characteristics are described in Table 1.
Data Collection
17. Interview/ focus group guide	An interview guide for caregivers (see Appendix B) was developed based on a conceptual framework of clinician- provider interaction in the tracheostomy decision-making process. The guide was revised as interviews progressed. The guide was not pilot tested. Focus group guides for clinicians (Appendices C and D) were developed based on a conceptual framework drawn from caregiver interviews as it relates to clinical interaction during the tracheostomy decision-making process.
18. Repeat interviews	Repeat interviews were not carried out.
19. Audio/visual recording	Interviews and focus groups were audio-recorded
20. Field notes	Field notes were completed by the interviewers/ focus group facilitator after the interviews/ focus groups.
21. Duration	The median length of interviews was 66 minutes (range: 35 to 175 minutes). The median length of focus groups was 68 minutes (range 59 to 92 minutes).
22. Data saturation	For interviews, the list of potential eligible participants was exhausted, resulting in 41 completed interviews. Because there was variability in children’s’ diagnoses, ages, survival, decannulation, and socioeconomic status, we wanted to be sure to get the most comprehensive picture of the pediatric tracheostomy experience possible. We reached data saturation on most themes prior to the final few interviews, but completed those interviews for the sake of exhausting our list. For Spanish-speaking subjects, their data was very similar to English-speakers, and very few in number. We feel they align thematically with the English-speaking data, contributing to data saturation. For clinicians, our goal was not to saturate focus group data, however to help us better understand the caregiver experience using clinical perspectives – triangulation. We achieved this.
23. Transcripts returned	Transcripts were not returned to participants for comment and/or correction
Domain 3: Analysis and findings
Data analysis
24. Number of data coders	Four data coders coded the data independently (2 per transcript) and reconciled differences in coding through discussion.
25. Description of the coding tree	A codebook was developed inductively and revised for accuracy as coding progressed. The final interview codebook had 19 codes; one code had 3 sub-codes and another had 4 sub-codes. For focus groups, a separate codebook was developed. It had 12 codes.
26. Derivation of themes	All themes were derived from the data.
27. Software	ATLAS.ti v.7 was used for data management and analysis
28. Participant checking	Participants did not provide feedback on the findings
Reporting
29. Quotations presented	Participant quotations are presented throughout the manuscript text. Each quotation is identified by participant number.
30. Data and findings consistent	Data that emerged related to this topic are summarized as themes.
31. Clarity of major themes	Three major themes related to this support needs and resources used by parents/caregivers are presented in the Results.
32. Clarity of minor themes	Subthemes are described within the major themes.

^1.Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–357.

^2.Green J, Thorogood N. Qualitative methods for health research. 4th ed. Los Angeles: SAGE; 2018.