Suitable candidates they identified by the researcher will be sent a patient information sheet with their chest pain clinic appointment letter inviting them to participate. Potential participants will receive a follow-up telephone call approximately 1 week later by one of the clinical triage cardiology staff, confirming they have received information sheet and asking if they would like to participate. If they agree by phone, understanding of the participant information sheet and written consent will be confirmed on the day of the chest pain appointment. An opportunity to ask further questions
will be provided before consent is taken by the researcher or designated assistant. This modus operandi allows sufficient time away from the hospital between receipt of the patient information sheet and giving consent.49 Patients who consent will be assigned a unique study number to identify them throughout the study. Data collection Semistructured interviews with key topics and probes will be used for two reasons. First, they enable a focused interview while allowing for rich data collection, including areas
not covered by the key topics.46 This design is optimal when balancing rich data collection against the operational and time limitations of an NHS-based academic study. Second, one-to-one interviews are recognised as the best form of data collection for sensitive topics including potentially serious health matters where little is currently known.46 The interviews will be conducted face-to-face in the researcher’s private office based in the cardiology department. The length of each interview will be dependent on individual participant responses. However, consideration will be given to the fact that very long interviews will be operationally difficult to accommodate in the NHS clinic, and introduce fatigue for both researcher and participant, potentially reducing the usefulness of participant responses.50 In
view of this, a maximum of 1 hour per interview will be set aside. All interviews will be transcribed verbatim using a professional Drug_discovery transcription agency. Although the agency will not receive patient identifiable information other than the circumstances where a patient identifies themselves in the digital recording, they will be asked to sign a confidentiality agreement in line with usual practice. The investigator will, on receipt of transcripts, check and anonymise them by removing all identifying information. Interviews will be undertaken by the same researcher to increase consistency.51 An in-depth semistructured interview process adopting the Berg style of questioning50 will be used to elicit the participant’s meaning-making in terms of cardiac symptoms and the decision to seek help. Berg’s style of questioning is useful when trying to draw out people’s opinions and experiences.