Practical Insights from Operationalizing a Remote Symptom Monitoring Program Using a Commercial Platform in a...

Remote symptom monitoring using electronic patient-reported outcomes reduces symptom burden and acute care use in oncology, but most programs have been established in academic centers or funded trials using purpose-built software. We examined how the REmote Symptom and Patient mONitoring System (RESPONSe) was implemented and subsequently funded as a recurrent clinical service at a Canadian community cancer clinic using a configured commercial platform, patients' own devices, and no formal institutional mandate. We conducted a qualitative post-implementation process evaluation at Richmond Cancer Clinic, British Columbia, reported following the Consolidated Criteria for Reporting Qualitative Research. Eight staff, purposively sampled by role and phase of involvement, were invited and participated, which consisted of one oncologist, three nurses, two virtual health staff, and two administrators. Interviews were analyzed using deductive-inductive thematic analysis. Three themes were identified: tailoring technology for clinical fit; designing care around patient and clinician users, centered on a dedicated symptom management nurse; and managing up towards operationalization. Operationalization was achievable using a customizable commercial platform, but depended on the interaction of iterative technology adaptation, dedicated clinical ownership, evolving care workflows, and sustained organizational advocacy. We propose five transferable implementation strategies mapped to established implementation frameworks.