Early and appropriate pre-implementation care team engagement [engaging deliverers]
The remote nature of the intervention was perceived as consistent with innovations in clinical practice (i.e., moving toward technology-enhanced care), but some stakeholders wanted to help adapt and tailor these new approaches. One clinical stakeholder stated:This is the wave of the future. If we can help shape it and be part of defining how this occurs, all the better for us versus just adopting tools that others have developed. (P10; Oncologist in leadership role)Some clinical stakeholders expressed concern that much of the E2C2 intervention had been developed without their input: “I think it seems like there was this agenda to get the intervention done without the stakeholders being very involved upfront.” (P16; Nurse Practitioner)Although it was important to engage stakeholders early, it was also important to share the right amount of information at a given time. In the absence of pertinent information, staff tended to speculate and fill in the gaps:It’s easy for somebody to hear some details, and then start speculating about things that are going to occur, talk to people about their thoughts that maybe aren’t founded on facts. You start to build this misunderstanding, and sometimes negative views of something that aren’t entirely correct. (P10; Oncologist in leadership role)Sharing information before things are finalized could also fuel concerns. When information sharing is premature, the implementation team may need to quell concerns that would not have arisen had they waited until the intervention components and implementation strategies had been finalized.Interviews also highlighted the challenge of randomizing practices to start the intervention at a future timepoint as part of the stepped-wedge trial design from an implementation readiness perspective. One clinical stakeholder stated, “If a cluster is coming, and that clinic happens to be particularly busy, or it’s a particularly busy time of year, it might be a little tougher to do.” (P17; Nurse Practitioner)