Table 6.

Perceptions about implementing the Bright IDEAS program in pediatric oncology practice among training participants before and after program adaptation.

RE-AIM dimension	Bright IDEAS forms -focus of adaptation	Representative quotes
		Initial curriculum (N = 33) (modeled from clinical research protocol)	Adapted curriculum (n = 14) (tailored for real-world clinical setting)
Adoption. Bright IDEAS is adopted by clinicians and practice settings	Identification of appropriate patient profile	“Individuals or parents that are ready to engage in problem-solving vs. they still need some initial time to process the diagnosis and get through potentially the aspect of degrees of denial at first, I would give them that time before I would embark on utilizing the Bright IDEAS paradigm.”	“The most successful family that I have used this [Bright IDEAS] with were parents who were very psychologically minded, had pursued therapy themselves throughout the years, and really were asking for psychology involvement at the time of their child's diagnosis.”
		“When I'm talking with families, if there's some anxiety or stress, or the parent is critical about something, I sort of put them on my sort of mental list of okay, this might be a good idea for Bright IDEAS.” “I don't have, and my colleague doesn't have the ability to really sit down with families and say, you know, “This is important, and, and we want you to use these tools.”	I pick parents that I feel are highly anxious…they're searching for some type of sense of control. I feel like using the form and guiding them through it [Bright IDEAS] gives them that.
Implementation. Bright IDEAS is implemented consistently into clinical workflow	Implementing Bright IDEAS in the clinical setting	“If I didn't have the forms with me, and I was meeting a family spur of the moment, I didn't have time to…run back to my office and get the forms…”	“It's [Bright IDEAS] very flexible in the way that we don't have to abide by a certain number of sessions …we can just use it however we see fit for every single family. So, I think that it is seamlessly worked into the work that I do...”
		“I may do a consult and then they're discharged and – and they don't necessarily come back to clinic.”	“I have been able to implement Bright IDEAS in all different settings. So, I have done it inpatient, I have done it on the outpatient side and certainly done it in clinic as well. It's possible”.
Maintenance. Bright IDEAS is maintained over time	Need for institutional support	“I think that something like Bright IDEAS is likely to be more popular and more widely disseminated at an institution where there is a big psychosocial team and a lot of buy-in...” “It's definitely not something that I get that's getting publicity and, you know, I don't know if it would change if it was more widely known by, like, attendings and the broader medical team, but if that would somehow change how well affected it is or how well known it is”	“So I think, having maybe more institutional support or I don't know if there was, you know any sort of incentive for providers to use it [Bright IDEAS].” “I'll tell you that I don't think I would have been able to go [Bright IDEAS training] had I not been reimbursed or had most of it not been reimbursed. If I had the financial support for ongoing training, that would be helpful.”

Source: Qualitative interviews (N = 47): pre-adaptation (n = 33) and post-adaptation (n = 14).