158 Chapter 6 A. Retrospectively describing the most prominent determinants of successful KLIK PROM implementation using CFIR The CFIR framework was used to retrospectively describe the implementation process of the KLIK PROM portal in different patient groups and hospitals throughout the Netherlands and to identify determinants in this process. Only the determinants relevant for the KLIK implementation process were described. To define which determinants were relevant for successful KLIK PROM implementation the following steps were taken. First, the KLIK PROM implementation process was described and discussed by the KLIK expert team, using all 39 CFIR constructs. However, for the reason of clarity, only the most prominent CFIR determinants relevant for the KLIK PROM implementation were extracted here (see Table 1). Second, the authors discussed which facilitators they found most prominent to describe. If the majority of authors considered a CFIR construct as valuable, it was included in the qualitative description. The KLIK implementation process was described based on published literature regarding the development, effectiveness, and implementation of KLIK in various settings and options for visual feedback of the PROMs (Supplemental Table 1) and unpublished literature (e.g., the KLIK user manual and training) about the KLIK portal and on experiences of the KLIK expert team. B. CFIR-ERIC Implementation Strategy Matching Tool to identify current barriers of the KLIK PROM portal implementation The CFIR-ERIC Implementation Strategy Matching tool v1.0 [31] was used to identify current barriers in the ongoing KLIK implementation and to match implementation strategies that address the identified barriers. The CFIR-ERIC tool is based on the CFIR framework and the 73 Expert Recommendations for Implementing Change (ERIC) implementation strategies [32]. During the development of this tool [30], implementation researchers and clinicians (panelists) were presented with brief descriptions of barriers based on CFIR construct definitions. They were asked to rank implementation strategies that would best address each barrier. Within the provided Excel tool, one can indicate which CFIR constructs are barriers to implementation. Five KLIK expert team members based in the Emma Children’s hospital Amsterdam UMC and three in the Princess Máxima Center for pediatric oncology involved in the implementation of the KLIK PROM portal independently indicated which of the 39 CFIR constructs were perceived as current barriers in the overall KLIK implementation. These eight expert team members include all authors. When the majority (5 or more members) of the KLIK expert team identified a CFIR
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