3.0, Randolph Massachusetts, USA) for coding qualitative data. Based on the principles of grounded theory (to develop a theory or explanation ie, grounded in the data collected)15 and thematic analysis, AT read the transcripts, conceptualised and coded all sections relating to radiologists’ perspectives on EBM into concepts identified inductively

Alisertib clinical trial in the data; and created new codes when necessary. These were reviewed by SEM who also read the transcripts. This can help to ensure that data were captured in the preliminary codes. Similar concepts were grouped into themes and subthemes. Patterns and conceptual links between themes were mapped into a thematic schema. Member checking was conducted whereby participants were sent a copy of the preliminary analysis and given

2 weeks to suggest additional opinions. These were integrated into the final thematic analysis. This ensures that the findings reflect and captures the full breadth of data from the participants. Results Twenty-five radiologists from 24 institutions across six Australian states and New Zealand participated. Non-participation (n=6) was due to travel and clinical commitments. The mean duration of interviews was 35 min. Participant characteristics are provided in table 1. Table 1 Participant characteristics We identified six major themes: legitimising decisions, optimising outcomes, availability of access, over-riding pragmatism, limited confidence, and competing powers. Illustrative quotations for each theme are provided in table 2/online supplementary file 1. A thematic schema illustrating the conceptual links among themes is shown in figure 1. EBM was believed to support clinical decision-making for optimal patient outcomes and service efficiency, but radiologists’ capacities to assimilate and apply EBM were limited by barriers to accessing and appraising the evidence, perceived need for

pragmatism and gaining practical experience, and contending with power hierarchies with referring physicians and commercial interests. A description of the themes and subthemes are provided in the following section. Most of the themes apply to interventional and diagnostic radiology; however results that were specific to either interventional (therapeutic) or diagnostic radiology will be indicated. Table 2 Illustrative quotations Figure 1 Thematic schema. Legitimising decisions Validated justification EBM provided a framework to make clinical Entinostat decisions based on science, rather than anecdotal data. EBM “added weight, added experience and evidence behind decisions.” And some participants felt reassured when research “validated their own experiences”, and EBM was regarded as an opportunity “to borrow information and techniques from other people who have been using them more.” Prioritising patient preferences Shared decision-making was regarded as important though some felt that patient preferences contradicted EBM.