Implications for E2C2 implementation
To address stakeholders’ concerns raised during the interviews, we made several intervention refinements and developed implementation strategies, as shown in Table Intervention refinements and implementation strategies developed in response to concerns identifed during pre-implementation• Presented clinical stakeholders with evidence supporting the care model• Tailored self-management materials to be symptom specific• Developed care team materials detailing how SCMs would manage SPPADE symptoms• Requested that SCM and E2C2 study team members periodically join a standing care team meeting to facilitate collaboration, joint problem-solving, care coordination, and role clarification• Given the duration of usual care for some clusters in the stepped-wedge trial, created a plan to repeat engagement with stakeholders prior to any practices starting the intervention phase of trial• Identified clinical champions and created roles for site-specific implementation facilitators (known as Symptom Sages) to act as a liaison between the care team and our study team and who were knowledgeable in the intervention components, including the EHR clinical decision support elements