Table 5.

Implementation: selected quotes from qualitative semistructured interviews and direct observations*

Theme	Quote	Participant type
Intervention characteristics	If there is an 80-year-old woman and a 20-year-old woman, where they are completely performing different things, I can tell the 20-year-old’s getting a little impatient	Physical therapist
	At the beginning, there were five people in a class, it was insanity. I feel like that was a lot of people …I feel like the patients had so many questions and needed so many different adaptations that it was very hard to give the amount of attention that each person needed	Physical therapist
Payment	I mean, the reality is that there are some financial constraints to this. And if I were referred to physical therapy, I would have no idea what my co-pay is, how much this is going to cost me. And maybe if there was some way to let patients know, or to give – and I know insurance companies vary widely, so maybe you don’t have the resources to do that	Oncology provider
	I think the largest barrier that I heard from women was the co-pay…the whole co-pay situation was very – I’ve got one woman, she had an $80 co-pay. And I tried to convince her. And we have so little control over that co-pay. I had never seen a co-pay that was more than $25…If we can’t get enough participants to sign up for the classes on an ongoing basis, I think there’s a financial hurdle to continuing to offer the class, despite our great desire to offer a wellness component	Physical therapist
Eligibility	I can’t actually remember the eligibility criteria…I know I should be thinking about patients to do [PAL]. I know – I recall that it has something to do with patients who have weight issues. But beyond that I can’t keep it in my head. I need tools.	Oncology provider
Referral	So the job of who is going to do the selling [of PAL to the patients]? I think it has become clear that that it cannot fall on us [medical oncologists]… We can’t do it. It is not going to happen at that course of the day when you are thinking about 79,000 other things. Selling this idea is going to have to be done by some external force and all we can do is cooperate and buy in and go along with it. It will be much more efficient I think	Oncology provider
	Everything you refer in the health system, once that [referral] goes in, even for social work or physical therapy/occupational therapy after [the patient is] discharged, I put it in ahead of time and then that goes to somebody’s inbox and that person calls [the patient]. It’s gotten to the point if I put in an MRI thing and then try to call down to radiology to schedule on the phone, they’re like ‘Well, you already put it in we don’t need you to call.’ Most places once you put that in they know it’s there, they’ll get to it when they get to it	Oncology Provider
Champion	If [champion’s name] wasn’t here, the physical therapy team would have said ‘I can’t, we can’t, too many roadblocks’ and would have given up much earlier on making this program happen	Physical therapist
Adaptation	The navigator position though, I think is… more for this issue of where do I send them? Figuring out the logistics of it. Am I sending them to this side or that side and what are the co-pay issues? You don’t want to be dealing with all that. You don’t have time to deal with all that	Oncology providers
	I think just the level of communication with how the program was supposed to be run was difficult. Being a very research oriented facility, we thought there was a strict program that needed to be followed and that the program that had been given to us was the program we had to rigidly abide by… I don’t think it was made clear that we had the flexibility to create our own program. And once we created our own program and implemented it, I think it’s been much more smooth because we are all well trained in exercise science and physical therapy and when we made it our own, it became much more natural to teach	Physical therapist

* MRI = magnetic resonance imaging; PAL = Physical Activity and Lymphedema.