Table 2. Facilitators and Barriers to Effective Replication.

Specific Challenge	Response/Solution
Extensive IRB approval process	During the waiting period, volunteers were recruited and trained as peers (initial PN training) Focused recruitment at Hospital A
Prolonged volunteer approval process	Postponement of start of study Informed volunteer office any forthcoming changes During the waiting period volunteers received additional PPN training
Unexpected death of professional staff navigator	Postponed recruitment
Lack of staff at Hospital B to facilitate informed consent process	Recruiters from coordinating site placed at hospital to perform informed consent and facilitate PPN PPNs completed training to facilitate informed consent
Low recruitment (due to appointment scheduling system)	Began randomizing by day of the week (instead of at level of participant) Elimination of pre-surgical testing before granting appointments Began recruiting at endoscopy suite (immediately after patients’ appointment with PCP)
Lack of space for peer navigator/recruiters	Professional staff navigators offer their space PPNs navigate on days when PNs are not in
Telephone-based navigation	Petitioned IRB for waiver of informed consent
IRB not willing to approve waiver of consent	Sought advice from NCI/NIH program director and IRB administrator from Hospital B. Decided to forego research study and adopted clinical service approach to eliminate need for consent