Table 2:

Intervention Adaptations based on the RE-AIM Framework by Stakeholder group

RE-AIM Dimension	Stakeholder Group	Feedback	Intervention Adaptations
REACH	Patients	• Tailor educational materials • Use social media to promote	• Language-specific educational materials including introduction packets at UHH registration, language-specific advance directives and goals of care documents • Use Facebook page and website to promote intervention
	Caregivers	• Invite caregivers to participate • Provide support groups • Use testimonials of patients to encourage others to participate	• Caregiver support groups • Intervention components to also incorporate caregivers specifically regarding education of goals of care and ways to support symptom management
	Providers	• Provide one point of contact for the intervention • Find a good name for the intervention • Provide opportunities for participants to engage with one another	• Identify one UHH champion at each site to contact one nurse champion at each oncology practice • Intervention name: Lay Heatlh Workers Educate, Engage, and Activate Patients to Share (LEAPS) • Provide caregiver support groups • Ongoing monthly team meetings • Create weekly lay health worker and UHH nurses and case manager meetings at each site
	Staff	• Encourage all beneficiaries to participate regardless of stage of disease • Use UHH registration to promote the intervention	• Include all stages of disease • Provide information packet at time of UHH registration
EFFECTIVENESS	Patients	• Measure activation. • Focus on quality of life	• Measure change in quality of life as the primary outcome • Assess patient activation measure on each patient
	Caregivers	• Measure caregiver distress • Provide opportunities for caregivers to discuss experiences	• Conduct bereaved caregiver interviews • Incorporate caregiver support groups
	Providers	• Collect process metrics that include how the intervention may impact provider time, number of contacts with patients, and number of contacts between UHH staff and oncology providers regarding patients in the intervention • Collect patient satisfaction with oncology care	• Include tracking of process metrics • Collect patient experiences with cancer care providers
	Staff	• Include patient and their caregiver experiences • Include measures that can impact budget requirements for the intervention (include total costs of care, healthcare use.)	• Secondary outcomes to incorporate total costs and healthcare use data. • Conduct patient and caregiver interviews to measure experiences.
ADOPTION	Patients	• Provide patient testimonials to other patients and to providers.	• Encourage participants to provide testimonials regarding program experience • Incorporate patient interviews into the evaluation
	Caregivers	• Provide caregiver feedback regarding successful and unsuccessful aspects of the intervention	• Include caregiver interviews into the evaluation
	Providers	• Create engagement among all providers to discuss the intervention on an ongoing basis • Engage other home-based agencies • Consistent and ongoing training and support for providers • Identify a champion at each site	• Monthly project working group meetings to encourage discussion regarding intervention components, • Quarterly training among all providers • Bi-annual training for lay health workers • Incorporate home-health agencies and local hospice agencies to participate
	Staff	• Provide ongoing feedback of intervention success to the union leaders and national medical director • Consistent and ongoing training to providers and lay health workers • Ensure the intervention is feasible to deliver across all settings by including common equipment (e.g., documentation resources for the lay health workers such as an electronic platform that is accessible across sites and standardized and standardized enrollment procedures)	• Collect and evaluate metrics of intervention success at routine intervals • Disseminate intervention results bi-annually to UHH leadership • Invest in a documentation platform standardized across UHH sites
IMPLEMENTATION	Patients	• Blend the format for delivery of services such as telephonic delivery of intervention and home visits • Tailored delivery of services based on patient preferences for communication of the services	• Incorporate patient preferences for delivery of intervention components. • Incorporate home visits
	Caregivers	• Telephonic or internet delivery of intervention • Need acute care transition interventions • Provide caregivers input to the lay health workers routinely	• Incorporate acute care transition intervention components • Incorporate caregivers in the intervention at time of patient involvement with lay health workers and through routine intervals to assess caregiver input
	Providers	• Ensure access to documentation of encounters with patients and caregivers between all providers • Weekly contact between UHH point of contact and provider point of contact to discuss patient cases • Incorporate ways to ensure fidelity to the intervention • Provide space to conduct the intervention	• Weekly report of patient cases with daily report if urgent • Protocol for intervention delivery with manual of training resources, • Provide space for intervention delivery in UHH union offices and UHH care centers
	Staff	• Conduct weekly case presentations to discuss ongoing cases • Make sure there is an ongoing team approach to the intervention delivery • Carefully consider funding considerations and how to get buy-in from all stakeholders routinely	• Create a weekly case presentation seminar open to all members of the care team • Conduct monthly project working group meetings to discuss goals and encourage ongoing team-based approach • Incorporate bi-annual presentation of intervention successes to the UHH leadership
MAINTENANCE	Patients	• Branding and promotion of the intervention at time of registration into UHH before cancer diagnosis may be important	• Create a new name such as Lay Health Workers engage, Encourage, and Activate Patients to Share (LEAPS) • Incorporate promotion materials at time of UHH beneficiary registration
	Caregivers	• Use of ongoing contact with small reminders, phone calls, emails and encourage caregivers to support long-term maintenance	• Provide newsletter to families and beneficiaries that highlight the program  • Incorporate caregiver support to encourage long-term commitment to program by members
	Providers	• Keep providers motivated and engaged • Certification for the lay health workers • Annual refresher trainings	• Bi-annual webinar series to keep providers encouraged • Monthly Project Working Group meetings to ensure engagement • Annual refresher trainings for lay health workers
	Staff	• Collect cost-benefit of the intervention for policy changes inside and outside of the organization • Continue to provide funding, provider and patient support	• Ongoing collection of important outcome metrics to determine budget impact analysis  • Ensure funding for stakeholder support through routine bi-annual presentations to the UHH leadership