Table 2.

Summary of pre-implementation information and how it informed implementation design

Aim	Data collected	Description of findings	Implementation strategies
To engage health professionals and patients	Physical environment mapped. Field notes. Focus groups/interviews with multidisciplinary team members and patient representatives of enablers and barriers Staff survey of knowledge modelled on Rouette’s et al 37 assessing knowledge about PROMs including facilitators and barriers, PROMs data format, enablers and barriers. Questions are scored on a Likert scale with questions such as ‘My understanding of PROs is…(very poor, poor, fair, good, very good)’, ‘My lack of understanding of PROs is a barrier to using them in clinical practice (almost never, rarely, sometimes, often, almost always)’.	The physical environment is busy but movement of patients, staff and medical records is established. There are many established treatment pathways for patient care based on disease group, stage of disease and treatment regimen. Previous interventions have been unsuccessful due to a lack of collaboration with staff and patients. Knowledge about PROMs and current evidence is different across health discipline groups.	Touchscreen computers will be positioned for easy access by patients as they enter the clinic area. PROMs reports will be made available to staff prior to patient encounter. PROMs data entry design and equipment were sourced in collaboration with consumer representatives. Information resources were developed in collaboration with staff and patient representatives, including posters, information sheets, staff brochures and inservice material.
To effectively incorporate technology	Field notes. Map of Information Technology Systems that interact with patient care, including the physical environment.	Many electronic medical records systems interact with patients and staff but not with each other. If PROMs data become a report, it can be stored as such in the patient’s medical record. Paper-based reports can be more easily integrated into patient records. Development of a system specific for each individual health service is expensive and time-consuming. It is unclear whether this would be integrated into current IT systems, or become another log on for staff, which reduces their likelihood of engagement. No ready-made system could be identified for purchase.	A simple electronic data capture system (REDCap) will be used to collect PROMs data and generate reports. A simple set-up provides the flexibility needed for integration and implementation while ensuring the fidelity of the intervention. Developing/funding a more sophisticated platform for collecting PROMs from patients can be informed by the successful implementation process.
To manage and respond to PROMs data	Focus groups/interviews and field notes to map referral and communication pathways iPARIHS context assessments of clinical areas.15	Reports can inform referrals in the format of documentation in the medical record, verbal communication or by email. The best approach needs to be identified with the relevant clinical team/area. Symptom assessment by clinicians uses CTCAE v4.0 as standard practice. CTCAE is the Common Terminology Criteria for Adverse Events, developed by the US Department of Health and Human Services which offers universal assessment and grading of symptoms of disease and treatment. Allied health and specialist nurse roles are in place for management of specific symptoms.	Alerts criteria will be generated directly to the appropriate specialist nurse and allied health team member to integrate into their practice. PROMs reports will be used to inform assessment and clinical decision-making.

iPARIHS, Promoting Action Research in Health Services; PROMs, patient-reported outcome measures.