Data Analysis
We used directed content analysis for codebook creation followed by
in-depth thematic networks analysis to explore supportive care needs
with CAR T cell therapy in pediatrics.25-29 The
multi-disciplinary analysis team included a health services investigator
with qualitative research expertise (KS), physician-researchers trained
in palliative care and pediatric oncology (AS, SS, DL, HS), a social
work clinician-researcher (LW), and clinical research staff with
qualitative research experience (KP, JN, DV). The research team used
directed content analysis to guide iterative codebook development and
coding structure, applying models of HRQOL and symptom burden (Appendix
B).23, 24 Starting with 5 transcripts, two coders (KS,
AS) independently reviewed transcripts in their entirety and deductively
applied the existing a priori codes for codebook refinement and
addition of codes thought to be missing. Separate codes for “patient
viewpoint” and “parent viewpoint” were used to organize perspectives.
We continued this process until no further code categories emerged and
consensus was reached.
Interviews and the finalized codebook were imported into Dedoose for
analysis [Dedoose Version 7.0.23 (2016). Los Angeles, CA:
SocioCultural Research Consultants, LLC www.dedoose.com]. A core of
five study team members (AS, SS, KP, JN, DV) reviewed five transcripts
together to establish a standard coding process. For the remaining 17
transcripts, two members of the core analysis team independently and
blindly coded each transcript. A third coder reviewed each transcript,
serving as a tie-breaker in code reconciliation. The core analysis team
met weekly to discuss inconsistencies, resolve discrepancies, refine
code definitions, and reach consensus.
After coding was complete, the full analysis team (AS, SS, KP, JN, DV,
DL, HS, LW) applied thematic networks analysis to examine recurring
concepts among interviews.27 The relationship between
concepts was then used to create basic themes. Basic themes were then
used to create three organizing themes. Organizing themes were
reorganized to deductively develop three overarching global themes
representing the unique perspective of pediatric patients treated with
CAR T cell therapy and their parents. Through an iterative process, the
study team refined and synthesized themes within the network until
inductive thematic analysis was reached.30