Table 1 Implementation Phases and Implementation Strategies

Phase 1: Setting the Stage

a. Promote awareness of the need for change through presentations-create a compelling vision for PROs on patient outcomes (i.e. rounding)

b. Engage key stakeholders at each site (patients, clinicians, IT leaders, administrative and disease site leaders) in a local implementation team (coalition) to facilitate practice change and integrate PROs in workflow

c. Complete readiness assessment to characterize current support for PROs implementation and barriers to tailor implementation strategies

d. Interactive educational meetings and focus groups to reach consensus on a visual format for the PROs symptom report (summary of scores).

e. Designation of disease site champions and opinion leaders to facilitate practice change within each site (internal practice change facilitation).

Phase 2: Active Implementation

a. Standardized clinician training using simulated case-based scenarios with standardized patients to model integration of PROs for personalized communication and treatment planning, tailoring of interventions to symptom scores, and activation of patients (how to change).

b. Interactive case-based education in disease site clinics to discuss response to scores and tailoring of guideline recommendations to practice (how to perform effectively). One-to-one role modeling if needed.

d. Educational brochures/videos targeted to increasing patient knowledge of PRO use for monitoring and guiding symptom self-management.

e. Foster integration of patient symptom management guidelines in patient education sessions as part of standardized approach.

Phase 3: Making it Stick

a. Engaged administrative leaders and provincial quality leads in sites/provinces to champion the change and performance accountability.

b. Disease site champions/opinion leaders acted as change management facilitators at monthly disease site team business meetings.

c. Collaborative all sites meetings with centralized program manager to share implementation strategies (external practice change facilitation).

d. Use of audit and feedback as an implementation strategy to show progress in screening rates and change in symptom scores.

e. Early discussion of sustainability and plans for sustaining the change.