Table 4 Summary of the themes, subthemes and supporting quotes

Theme 1: Perceived usefulness

Subtheme 1a:

Usage behaviour aligned with providers’ typical approach to care

Varying approach to care and ePRO’s alignment with providers’ care approach

“Normally, we do goals and then get [patients] into programs. I don’t often see people ongoing…I didn’t even really do a whole lot with the ePRO in between. Like it was the set up was the biggest part of it then after that it really didn’t, you know, come into play" (GBP02)

“So this was just, almost the way of, in some cases, I didn’t have to call, because I could just see [on the ePRO] that things were going well or not. And then make a phone call based on that” (P01OV)

Subtheme 1b: Impact and value of ePRO

Value added by ePRO

“A lot of times we just ask patients like oh, what do you want to improve or how do you think you're going to do this, but the tool actually makes it in a concrete way and puts it down on paper or a phone or tablet or whatever so that they could visualize and see it and make it simple for them” (MSP03)

“I’ve had a few patients whose health significantly deteriorated. So, one of them we redid her goals last week—or two weeks ago, because she felt [ePRO] was pressured” (GBP02)

“[ePRO] forced a little bit of structure and, you know we try and help people be more specific and really set specific goals and think about, you know what outcomes they want to see” (GBP02)

Subtheme 1c: Alignment with existing workflow may influence usage behaviour

Poor fit between ePRO and providers’ existing workflow

“[ePRO is] not hard to use. It's just that it's an extra step. And so it isn't much time, but when you have little time, if it was, like you said, integrated into the system already, I think you'd be much more likely to use it than having to go and then sign into something else” (MSP02)

“Yeah. I think though it's not easy to access it, right? Because if I'm already doing this and documenting in my chart, I'm just going to go to my previous chart note and look at what the goal was that I documented there. Versus this where it's an extra step where you have to sign into a system, right? So I think that is what makes it that might be a barrier to using it. So if it was integrated into the system that we're already using obviously it makes it easy, the appointment's going to flow easier, everything's going to happen quicker” (MSP01)

Theme 2: Behavioural intention

Subtheme 2a: High behavioral intention

Providers’ willingness to use ePRO

“I think I would certainly be interested in trying it with more people and seeing, you know, what that looked like with different types of patients, at different stages” (GBP05)

“It’s definitely easy to goal-set, I think my mindset is, you know, trying to see patients and sometimes I think you really need to set aside time, to really go over the goals and details. And so, I think what I did maybe incorrectly is try to do all of the [E-PRO] in one session, like do all of the goal-setting in one session, which isn’t realistic. And probably looking forward, is to do goal setting but it doesn’t all have to be in one sitting, to, to get all of the goals set, and how they’re going to achieve those goals and how we’re going to measure those goals. I think those things could be done over a long period of time, rather than trying to do it all at once” (MSP03)

Subtheme 2b: Low behavioral intention

Providers’ lack of buy-in to ePRO

"For me—I was—because I was one of—more the leaders of—I was sort of pushed into it quite honestly—it wasn’t a volunteer thing. And I’ll be honest, I’m not—I was—I’m a bit of a realist, a bit skeptical about some things. Not passionate about it, it was a project. I was a bit skeptical… It’s not a tool, like to be honest, that I would say I’d want to use" (GBP02)

“The patient he wasn't really interested in it so yeah, there wasn't too much use of it” (MSP01)

Subtheme 2c: Behavioral intention changed over time

Change in degree of interest in ePRO over time

“The initial excitement happened, but then the [research] process took such a long time that the excitement disappeared” (PO2OV)

“I think when you're having a conversation and not using the tool I think the conversation flows a little more easily versus when you're trying to plunk wording into a template” (MSP01)

Theme 3: Improving usage behaviour

Subtheme 3a: External factors may influence usage behaviour

Recommendations to enhance providers’ usage behaviour relating to external factors

“I could imagine that if we were going to carry on, there would need to be that reinforcement because I think it's not just reinforcement, it's also—it also makes the providers a bit more accountable” (GBP04)

“Hmm. Yeah, you’d need a lot. You’d need IT support. You’d need funding. You’d need training, definitely right?…And yeah, training not just for us, but also for the patients, like. And support for patients as well. Because the teaching usually supports us—like the provider, right. But sometimes, the patient needs that IT support too” (GBP01)

Subtheme 3b: Perceived ease of use may influence usage behaviour

Recommendations to enhance providers’ usage behaviour relating to ePRO’s perceived ease of use/usability

“I suppose support if there's any glitches because to me technology always has glitches, easy support, but it has to be embedded in. It has to be something I pull up, and I'm like oh, I'm using this tool to set goals with the patient, they have it in their system but I have it already in mine” (MSP04)

“I think overall it was fairly easy to use. I think it's just the wording, like just how the question was set up. I think it's just maybe not the way I'm used to do it. So I remember part of it seemed redundant. So it was just kind of thinking about, thinking a little bit harder about okay, what do I put here and what do I put there and what do I put here so that it all makes sense. Hopefully that makes sense to you… I think when you're having a conversation and not using the tool I think the conversation flows a little more easily versus when you're trying to plunk wording into a template” (MSP01)