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