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telephone, depending on participant preference. Interview data were analyzed on an ongoing basis until saturation of themes, or no new emerging major constructs, occurred. Saturation was reached after 15 interviews, which falls within the reported range for this type of qualitative study approach [26]. Trained interviewers used a discussion guide consisting of nine open-ended questions, and probes, directly relating to the study's objectives A brief background survey was administered at the end of the interview, to gather demographic information. The interview guide was pretested through five cognitive interviews with primary care physicians practicing in the NorthShore University HealthSystem, and revisions were made based on suggestions from these interviewees, as well as from internal and external expert reviewers [27]. Data analysis Interview discussions were transcribed and independent checks, by two investigators, confirmed accurate and verbatim transcription. Transcripts were uploaded into Atlas.ti (version 7.0), a qualitative data management and analysis software program. This type of software can create a document system to store and retrieve coded text, search for words and phrases in the text, and create an index system to link categories and data [28]. The discussion guide was first used to develop a provisional list of codes. These codes were refined and changed as new ideas were encountered in the reading of each interview transcript. A final codebook of 18 codes, with definitions and quotation examples, was utilized by the investigators to identify key opinions and themes. Two investigators independently coded each transcript and worked collaboratively to resolve any coding discrepancies. Grounded theory was used as a general guide to allow themes and theory to emerge from the transcript data [29]. The themes were collectively explored and interpreted by the research team. Data reduction and analysis were conducted through standard qualitative methods of coding, notation and theme identification [30]. Results Participant characteristics A total of 15 primary care physicians, from six practice sites, participated in this study. Slightly more than half (60%) were females and all participants spent 51% or more time in patient care. The majority (73%) specialized in internal medicine, and their years in practice varied from less than five to greater than 21. Participants had undergone PGx testing themselves and most (80%) of the physicians had ordered between one and five PGx testing kits for their patients. Based on investigator team analysis of the qualitative interview data, three broad themes were identified regarding views toward direct access PGx testing: perceived value and utility; challenges to implementation in practice; and provider as well as patient needs going forward. Each of these broad themes included sub-themes of related concepts. The themes and sub-themes are described, along with exemplary quotes from the primary care interview transcripts. Value and utility of direct access PGx testing was one of the key themes that emerged, and participants described these concepts in a number of ways. Two sub-themes describing value included how test findings can be used to guide primary care decision-making in particular contexts, and how information from testing can lead to specific positive outcomes for patients. Guiding primary care medical decision-making Most participants felt that undergoing direct access PGx testing themselves was a useful teaching tool and that it was helpful for them to have first-hand knowledge of the testing and resulting process. To them, this translated into providing better and more concrete information to patients regarding testing and decision-making. One of the participants (P14) described his PGx testing experience with the take-home kit: “Oh, it is very useful. It was easy. And when I'm explaining it to patients I tell them exactly how to do it, not, ‘You'll get a kit and then the instructions will be there’. I tell them, ‘You're going to swab for thirty seconds here, thirty seconds there, a minute over here. You're going to let it [the sample] dry’. I give them the full details”. This provider discussed how going through
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