1. A feasibility study to explore patient, clinician and GP decision making of acute recurrent tonsillitis for NATTINA: The NAtional Trial of Tonsillectomy IN Adults Dr Lorraine McSweeney

2. A qualitative approach The integration of qualitative research within difficult to conduct randomised controlled trials is recommended to improve their feasibility, design and conduct (de Salis, et al., 2008) Qualitative research focuses on human experience and social life including people’s use of language (Ward et al., 2013)

3. Study aim The aim of the feasibility study is to assess: The practicality of the proposed internal pilot and full scale randomised controlled trial – NATTINA: the National Trial of Tonsillectomy in Adults

4. Research objectives Evaluate professionals’ willingness to randomise Evaluate patients’ willingness to be randomised Define criteria acceptable to all stakeholders Establish primary care clinicians’ willingness to refer patients Assess the acceptability of usual care treatment Investigate the feasibility and acceptability of the proposed data collection methods and outcome measures

5. The participants Aberdeen Royal Infirmary Ninewells Hospital Dundee Glasgow Royal Infirmary Freeman Hospital Newcastle Sunderland Royal Infirmary York Hospital Bradford Royal Infirmary University Hospital Birmingham Guy’s Hospital London

6. Who? General practitioners ENT staff (including research staff) ENT patients Adults with acute tonsillitis who have been referred to otolaryngology outpatient clinics for recurrent sore throat

7. Method ENT, research staff and GPs Telephone interviews (15-30 mins) Open ended questions using topic guide E.g. Can you describe how patients with recurrent sore throats are managed Patients Face-to-face interviews (30-60 mins) Open ended questions using topic guide E.g. If you were able to avoid a sore throat how much would you be willing to pay a day? Willingness to be involved in research – role play Material and method testing – completion of questionnaires etc.

8. Analysis Framework analysis A qualitative thematic data analysis Flexible Systematic Rigorous Offers: transparency, clarity and an audit trail for stakeholders The data will be repeatedly read and coded independently by two researchers within a framework of a priori issues and those identified by participants or which emerged from the data

9. Outcome To consider: How well trial processes and interventions are introduced and incorporated at the nine sites for both patient and professional groups

10. Progress to date Staff interviews Aberdeen: 1 Glasgow: 1 Dundee: 1 Newcastle: 2 York: 4 Bradford: 2 London: 1 Scheduled – Dundee: 1 Patient interviews Aberdeen: 2 London: 1 (telephone) Scheduled - Aberdeen: 2 Dundee: 1 London: 1

11. This project was funded by the National Institute for Health Research (NIHR) Heath Technology Assessment (HTA Programme (project number 12/146/06). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA, NIHR, NHS or the Department of Health.