Iris Kanera

71 The Kanker Nazorg Wijzer protocol 3 different fields, talking about topics such as exercise, diet, return to work, anxiety and depression, lymphedema, and peer support groups. With these news items, we aim to keep the participants involved in the KNW by referring them to the module that is related to the topic discussed in the news item. Forum The KNW has a forum where fellow survivors can meet and ask each other or members of the KNW team questions. Participants are kept anonymous and the KNW teammonitors the forum to control for advice contradicting the advice given in the modules. Pretesting and revising The KNWwas pretested among 13 cancer survivors. In general, the appearance and content of the KNW was highly appreciated. The modules were evaluated positively ( M  = 7.6, range = 1-10). Particularly, the videos of fellow survivors and professionals were highly rated ( M = 8.0, range = 1-10). The mean scores for understanding, usefulness, reliability, applicability, completeness, and appearance of the KNW ranged from 3.3 to 3.7 (range = 1-4) and, therefore, were also highly appreciated. Some of the texts were evaluated as fairly long. Consequently, an editor reviewed and edited the text on readability and length. Furthermore, the tailored advice was evaluated to be of great value. While the tailored messages were computer generated, some participants initially thought that a person provided these messages. Although this demonstrated the power of tailoring, it also confused the participant when an answer did not fully match his or her expectations. Further, while the aim of the KNW is to stimulate participants to create their own solutions, some participants expected to receive personalized solutions to their problems. To address these issues, we included the previously mentioned instructional videos to explain how the KNW works and what participants can expect. After some final adjustments, the KNW was ready for implementation and effectiveness testing. Step 5: Adoption and implementation In the fifth step, a plan for program adoption and implementation was developed (Bartholomew et al., 2011) in the context of testing the effectiveness of the KNW in a randomized controlled trial (RCT). We created a network with representatives (e.g., department heads, oncologists, research nurses, and nurse practitioners) from several hospitals’ outpatient clinics in internal medicine, oncology, gynecology, urology, and the breast clinic. 45 hospitals in theNetherlandswere contacted for assistance in the recruitment. 21 hospitals agreed to participate, with 21 hospitals eventually participating in patient recruitment. Reasons for refusing participation included: hospital was already participating