Table 4 Overview of survey amendments required based on cognitive interview feedback (adapted from Drennan field guide [37])

Lexical problem/Comprehension

Minor lexical issues emerged that required clarification e.g. removal of abbreviations, minor wording changes, and clarification that parental dis/agreement referred to dis/agreement with the medical team.

All clinical experts spent time reflecting on the term ‘complex medical needs’. Some alternatives were considered, such as chronically critically ill. However, all reviewers concluded that for the purposes of the survey, the existing term was most appropriate in the context of the question.

Logical problems

Layout of vignettes followed by questions on demographic profile was deemed to flow well. Some clinical experts felt the vignette text itself should have minor modifications to enhance flow as a case study presentation.

Retrieval from memory of relevant information /Cognitive load

The majority believed eight vignettes was appropriate. One indicated possible saturation at six (this was revisited at the pilot study stage and eight was considered feasible). The order of vignette presentation was amended

All clinical experts suggested emphasising the need to instruct the survey participants to read each individual vignette carefully given the subtle differences when levels of factors were changed.

Clinically appropriate content

Some of the wording was changed to enhance clinical clarity

All suggested the need to emphasise the chronic nature of deterioration

Additional areas (Cultural considerations; Response; Temporal issues, Comfort (i.e. did any aspects of the survey make the interview uncomfortable); inclusion/exclusion problems)

No issues emerged.