Fit of the intervention with existing practice workflows [compatibility]
fits, NCCN distress, ’ desire
Despite their shared health system affiliation, individual practices had different symptom screening and management processes in place. Thus, stakeholders held mixed views on whether the intervention represented an improvement to usual care. For instance, one practice already had robust interdisciplinary workflows and care pathways in place for symptom screening and management:We have the NCCN distress tool... It meets our QOPI requirements. We have a process here that includes the scheduling staff, the providers, social work, behavioral health, nurse manager, with all of that. That’s really with symptom management, not only physical symptoms, but emotional symptoms. Then we already have occupational therapy embedded. (P20; Oncologist)A clinical stakeholder from another practice noted that their routine procedures for patient symptom assessment were not accompanied by guideline-based management so this intervention could fill that gap:The questions when they’re roomed… it does kind of perk my ears up about certain things to pay attention to, but I think without a dedicated intervention to try to help, that becomes less meaningful, and so I think the idea of having both the survey but also the intervention kind of built in is gonna be the most helpful. (P3; Oncologist)Due to the diversity of practice workflows and patients served, there was tension between stakeholders’ desire to adapt the intervention to fit the needs of their practice and patients and the need for standardization for research purposes. One clinical stakeholder noted:I think that the input that you get really does have to be implemented. It might not be the same for every site. I know for research it does have to be one size fits all in terms of protocol, and process... (P20; Oncologist)