Adaptation and implementation of a multinational eHealth intervention for people with cancer : reflections from the field

Furlong, Eileen and Darley, Andrew and Fox, Patricia A and Buick, Alison R and Kotronoulas, Grigorios and Miller, Morven and Smith, Robert and Miaskowski, Christine and Patiraki, Elisabeth and Katsaragakis, Stylianos and Ream, Emma and Armes, Jo and Gaiger, Alexander and Berg, Geir V and McCrone, Paul and Donnan, Peter and McCann, Lisa and Kearney, Nora and Maguire, Roma (2018) Adaptation and implementation of a multinational eHealth intervention for people with cancer : reflections from the field. Journal of Medical Internet Research. ISSN 1438-8871 (In Press) (

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Background: There has been an international shift in healthcare which has seen an increasing focus and development of technological and personalized at-home interventions which aim to improve health outcomes and patient-clinician communication. However, there is a notable lack of empirical evidence describing the preparatory steps of adapting and implementing technology of this kind across multiple countries and clinical settings. Objective: To describe the steps undertaken in the preparation of a multinational, multicentre randomized controlled trial to test a mobile phone-based remote symptom monitoring system, i.e. Advanced Symptom Management System Remote Technology (ASyMS), designed to enhance management of chemotherapy toxicities amongst people with cancer receiving adjuvant chemotherapy versus standard cancer centre care. Methods: Multiple steps were undertaken, including; a scoping review of empirical literature and clinical guidelines, translation and linguistic validation of study materials, development of standardised international care procedures and the integration and evaluation of the technology within each cancer centre. Results: ASyMS was successfully implemented and deployed in clinical practice across five European countries. The rigorous and simultaneous steps undertaken by the research team highlighted the strengths of the system in clinical practice, as well as the clinical and technical changes required to meet the diverse needs of its intended users within each country, prior to the commencement of the randomized controlled trial. Conclusions: Adapting and implementing this multinational, multicentre system required close attention to diverse considerations and unique challenges, primarily related to communication, clinical and technical issues. Success was dependent on collaborative and transparent communication amongst academics, technology industry, translation partners, patients, and clinicians as well as a simultaneous and rigorous methodological approach within the five relevant countries.


Furlong, Eileen, Darley, Andrew, Fox, Patricia A, Buick, Alison R, Kotronoulas, Grigorios, Miller, Morven, Smith, Robert, Miaskowski, Christine, Patiraki, Elisabeth, Katsaragakis, Stylianos, Ream, Emma, Armes, Jo, Gaiger, Alexander, Berg, Geir V, McCrone, Paul, Donnan, Peter, McCann, Lisa, Kearney, Nora and Maguire, Roma ORCID logoORCID:;