Document is current

Article History

Received: 17 April 2026

Accepted: 10 July 2026

First Online: 20 July 2026

Declarations

Ethics approval and consent to participate: The Medical Ethics Research Committee of the Isala hospital in Zwolle in The Netherlands confirmed that no ethical approval was required (reference: Niet WMO 200,318 PREDOCS implementation, multicenter). All participants provided informed consent prior to participation. At the time of ethical approval and participant consent, LLM-assisted analysis was not planned, as institutional guidelines for generative AI in qualitative research were not yet established. Participants provided oral informed consent; a non-WMO declaration confirmed the study fell outside the scope of the Dutch Medical Research Involving Human Subjects Act. Prior to analysis, all transcripts were rigorously de-identified, ensuring that no personal or institutional identifiers were processed by the AI platform. As the analyzed text contained no personal data as defined under the GDPR, this processing fell outside the scope of personal data regulation.

Consent for publication: All 12 cardiac surgery centres have consented to participate in this study. They were verbally and in writing informed about the contents and have given written consent by signing a contract. All participant quotations included in this manuscript have been anonymized.

Competing interests: The authors declare no competing interests.