TABLE 5.

Implementation Strategies for Future Trials

	Barriers		Potential Strategies
Barriers to Reach of Study	Limited pool of participants eligible for the study	Strategies to Improve Reach of Study	• Expand the inclusion criteria to other surgical populations • Extend to additional hospital sites
	Limited pool of participants to approach due to participation in competing trials		• Conduct local consensus discussions with other clinical research trial teams • Identify and prepare clinician champions. • Use advisory boards and workgroups to support institutional readiness and participant engagement • Increase awareness of trial across the institution
	Limited representation of diverse and historically marginalized participant groups		• Tailor recruitment script to welcome historically marginalized groups • Train research team on cultural norms and sensitivity • Modify study incentive/allowance structures based on the number of surveys/interviews
	Single recruitment method using telephone contact		• Distribute educational materials about the study and the intervention process and content details • Incorporate additional recruitment methods (e.g., text, in-person clinic visits, mass media, surgeon referrals, patient portal)
	Increasing number of participant declines at the screening and consent stage		• Tailor recruitment language (easy to understand and concise) • Emphasize the added value and benefits to participants with intervention and its impact on surgical outcomes • Highlight the patient-centered aspect of intervention and its flexibility • Highlight the no-cost structure of the intervention • Provide study incentives to all participants (e.g., in an RCT, incentives to both groups) • Provide all patients with wellness resources (for e.g., in an RCT, resources should be provided to usual care) • Invite patient champions to help with recruitment efforts
Barriers to Reach of Intervention	Missed intervention sessions Intervention drop-outs	Strategies to Improve Reach of Intervention	• Involve patients/caregivers in finding ways to enhance reach, uptake, and adherence • Interact with patients with attention to compassion • Promote intervention flexibility based on patient needs and comfort (e.g., simple-to-use activity schedules and tracking forms) • Reduce time and effort commitment for intervention sessions to accommodate patients’ schedules (e.g., increasing or reducing session frequency)