Strengths and limitations
cancer
CANCER, STILL
This study took the novel approach of characterizing barriers and facilitators to implementation of an ePROM-facilitated remote symptom management intervention for patients with cancer during the pre-implementation phase. Although it is unclear to what extent our findings are generalizable outside our health system, our health system sites did vary in size, rurality, and academic vs. community practice. The majority of those we interviewed worked at our large, academic medical center in Rochester, MN, while fewer interviewees worked at our more rural, community health system sites, which in part reflects differences in staffing and patient volumes. However, it is possible that for smaller health system sites from which we only conducted one interview, perspectives of other staff may have been missed. Nonetheless, these interviews still yielded valuable insights into different clinics’ practice workflows and populations served and identified important barriers and facilitators to implementation. Adding further credibility to our findings is the fact that many of our findings align with past research exploring barriers and facilitators to implementation of PROs. The use of a robust and longstanding implementation determinants framework in analysis may also foster transferability to other settings. Still, it is also possible that our findings suffer from self-selection bias and reflect the views of those who agreed to participate in an interview. However, the fact that interview findings revealed both facilitators and barriers to implementation suggests that interviewees were not limited to those who felt overly positive or negative about the intervention. Lastly, we did not gather patients’ pre-implementation perspectives to help refine the intervention, but their perspectives will be elicited as part of the larger E2C2 trial.