Table 3 TrACER implementation recommendations mapped to corresponding PRISM domains
PRISM Domain | PRISM key suggestions | TrACER implementation experience |
|---|---|---|
Intervention Organizational Perspective | Assure processes coordinate needs of all stakeholders | Working with clinical stakeholders to identify the most commonly prescribed chemotherapy regimens could have reduced the time and effort needed for sites to implement the reconfiguration. (recommendation 1) |
Intervention Organizational Perspective | Simplify the intervention while maintaining essential elements | Distilling the intervention requirements into a concise set of expectations interpretable across practice settings increased site buy-in while maintaining fidelity. (recommendation 2) |
Intervention Organizational Perspective | Assess the usability and adaptability of the intervention | Building flexibility into the protocol and allowing for additional time to implement allowed us to accommodate variation in workflow. (recommendation 3) |
Intervention Organizational Perspective | Design monitoring so results can be seen early | Collecting feedback during and after the intervention from site principal investigators and clinical staff could have improved delivery of the intervention and informed the design of future CCD trials. (recommendation 4) |
Characteristics of Organizational Recipients | Use existing staff during early stages to ease implementation | Sites preferred to use their existing IT teams to make changes to their order system so the external technical consultants were used in an advisory and supportive role. (recommendation 5) |
Characteristics of Organizational Recipients | Work with all levels of management to earn and communicate program support Engage clinical leaders from planning through implementation and maintenance stages | Funding for two full time research support positions allowed the study team to cultivate and sustain strong relationships with clinical leaders, managers and other key staff positions at participating sites, staff multiple channels for communication, and be responsive to site concerns. (recommendation 6) |
External Environment | Work with policy and decision makers to alleviate burden or provide incentives when possible | We worked with payer stakeholders to provide information about reimbursement for guideline-informed PP-CSF prescribing to help alleviate site concerns and offered to work with them to develop a reimbursement mechanism if this became an issue during the trial. (recommendation 7) |