Table 2 Determinants to implementation reported by the included interventions
From: Implementation of electronic prospective surveillance models in cancer care: a scoping review
CFIR domain and constructa | Barriers | Facilitators | n (%) |
|---|---|---|---|
1. Intervention Characteristics Attributes of the ePSM that is being implemented | 29 (63) | ||
Complexity Ease/difficulty of using the system (patients and staff) | • Too many questions to complete • Difficulties understanding the questions • High volume of symptom alerts • ePRO reporting is too frequent • Difficulties interpreting ePRO scores • Challenges navigating the system and locating ePRO scores and/or graphical results | • Acceptable and appropriate length and duration of ePROs • Acceptable frequency of ePRO reporting • Questions are clear and easy to understand • User-friendly system that is easy to navigate | 25 (54) |
Relative Advantage Benefits of using the ePSM versus existing assessment practices | • ePROs are redundant with questions asked during clinic visit • ePSM information provided to patient conflicts or is redundant with information provided during the clinic visits | • Perceived improved symptom identification and management • Perceived improved patient-provider communication • Ability to personalize discussions with patients | 23 (50) |
Design Quality & Packaging Visualization and presentation of symptom scores, services provided/recommended, and overall design of the system | • Inability to view history of ePRO scores • Lack of clarity for whether high scores or specific colours displayed indicate better or worse status • Self-management material related to symptoms of concern are not highlighted or specified | • Clear and appealing visualization and presentation of past ePRO scores in graphical format • Ability to view a list of resources recommended to patients | 14 (30) |
Adaptability The ability/need to have an ePSM that can be adapted and personalized | • Inability to modify and tailor the questions, timing of reporting, and content provided to patients | • Ability to tailor the questions provided to patients based on their responses | 5 (11) |
Cost Costs associated with ePSM implementation | • Extra costs needed to implement the ePSM are not covered by health insurers or government | NR | 2 (4) |
2. Inner Setting The organizational and cultural contexts in which ePSMs are implemented | 22 (48) | ||
Implementation Climate Absorptive capacity for change, shared receptivity to ePSM implementation, and the extent to which ePSM will be supported and compatible within existing processes in the organization | • ePSM is not integrated with electronic medical record and staff need to log into a separate system to access ePRO scores • Concerns ePSM implementation will increase workloads • Concerns ePSM implementation will prolong visit times • Previous unsuccessful experiences with implementation initiatives • Limited to no experience using ePROs | • ePSM is integrated with electronic medical record and ePROs are easily accessible to staff • Workloads are not increased • Clearly communicated and ongoing monitoring of implementation goals | 20 (43) |
Readiness for Implementation Organizational commitment to ePSM implementation including leadership engagement, available resources, and access to appropriate and sufficient information about the ePSM | • Lack of time for staff to use ePROs during clinic visits • Lack of information about the ePSM for clinic staff to use during clinic visits (guidelines and algorithms on how to manage high scores) • Insufficient resources respond to symptoms identified by ePSM | • Support from leadership and senior management • Availability of volunteers to educate and support patient completing ePROs in clinic | 12 (26) |
Networks & Communications Nature and quality of social networks and communication within an organization | • Limited communication between disciplines • Concerns other disciplines may not engage in the implementation effort and lead to a disproportionate burden on some staff | • ePSM implementation increased teamwork among clinical staff • Agreement about the division of roles and responsibilities among implementation, clinical, and software teams | 3 (7) |
3. Outer Setting The broader context within which an organization implementing an ePSM is situated (i.e., external influences) | 19 (41) | ||
Patient Needs & Resources Specific needs of patients that were/were not met or that demonstrate a need for an ePSM | • Perceived lack of relevance and usefulness of the ePSM questions and/or content • ePRO and/or self-management material are not tailored to the individual patient | • ePSM questions and content is perceived as relevant, useful, and meaningful for patients • Perceived improved attention and insight into patient symptoms • ePSM use provides a sense of reassurance and reduced uncertainty about symptoms • ePSM use provides a sense of empowerment and control | 18 (39) |
Cosmopolitanism Degree to which an organization implementing ePSM is networked with other external organizations | • Limited connections with other services successfully using ePROs | • Ability to involve other providers such as patients’ general practitioners to ensure that key information regarding their clinical care was not overlooked | 2 (4) |
4. Individual Characteristics Attributes of the individuals involved in the implementation of an ePSM | 16 (35) | ||
Knowledge & Beliefs Attitudes toward and value placed on the ePSM, including familiarity with principles related to the ePSM | • Lack of knowledge and awareness about the ePSM features, content, and aims • Lack of knowledge on how to complete ePROs • ePROs not perceived as valuable for clinical practice | • Knowledge and understanding of ePSM features, content, and aims • Strong professional values for the use of ePROs for clinical practice • Belief that symptom management is within staff’s scope of responsibilities | 8 (17) |
Other Personal Attributes | • Lack of comfort, experience and access to technology and internet • Patient is too ill to report symptoms | • Prior experience with using technologies and internet | 10 (22) |
5. Process Active change processes used to implement ePSMs | 14 (30) | ||
Engaging Attracting and involving appropriate individuals in ePSM implementation, including opinion leaders, champions, change agents, key stakeholders, and patients | • Educational strategies (e.g., handouts) not used by patients • Information provided to patients was not clear • Insufficient amount of training provided to patients and staff • Inability for patients to self-register to the ePSM | • Engaging a broad group of stakeholders • Involvement of champions and respected peers • Acceptable duration and timing of educational and training strategies • Provision of reminders for patients and/or staff to use ePSM • Availability of support for practical and technical issues | 13 (28) |
Reflecting & Evaluating Feedback about the process and quality of ePSM implementation | • Implementing the ePSM across many different sites at once • Clinic staff are not provided with a specific strategy to incorporate ePROs into workflow | • Use of a flexible and iterative approach to implementation • Use of data and regular meetings with stakeholders to track and monitor implementation | 4 (9) |