How to bring nurse-led eHealth symptom monitoring in daily care: the Belgian SMILe integrated care model for allogeneic stem cell transplantation adaptation project.

The SMILe (allogeneic SteM cell transplantation faciLitated by eHealth) integrated care model (ICM) offers a transformative approach to routine transplantation care by combining eHealth technology (a patient-facing App for home symptom registration) with monitoring, self-management support and care coordination carried out by an advanced practice nurse (APN) team. Implementing the SMILe-ICM in a setting with an existing eHealth infrastructure and APN support requires context-specific adaptations. Our aim was to adapt the SMILe-ICM to our local setting, guided by a prior context analysis. We followed the ADAPT guidelines, with stakeholder involvement from patients, informal caregivers and the local clinical, IT and legal teams. Using the Framework for Reporting Adaptations and Modifications-Expanded (FRAME), we documented key adaptations. We used the Expert Recommendations for Implementing Change (ERIC) taxonomy to select promising implementation strategies. Key required adaptations included using the local electronic eHealth platform to enhance usability and enable multiple provider access to patient documented data and reducing APN intervention sessions from 12 to six during the first year post-alloSCT to address financial constraints. Minor adaptations included revising content and simplifying language. Further, we selected 20 tailored implementation strategies focused on understanding the local context, involving key stakeholders, preparing a pilot trial, and training healthcare providers and patients for implementation. Real-world adaptation requires balancing the intervention's core components with the technical, regulatory, and resource constraints of the local context. Structured adaptation and strategic implementation planning were essential to support long-term sustainability.