An integrated knowledge translation and patient-oriented research approach and pragmatic orientation have been adopted [75-77]. A multiple-perspective study with key research user groups is underway. Relevant reporting guidelines will be followed when preparing and reporting results from this work (eg, FRAME [an expanded framework for reporting adaptations and modifications to evidence-based interventions] and Standards for Reporting Qualitative Research [78,79]). Selected implementation frameworks, tools, and models are informing this work, including the Consolidated Framework for Implementation Research (CFIR) 2.0 (a framework that identifies multilevel factors influencing implementation [80]), the CFIR-Expert Recommendations for Implementing Change Implementation Strategy Matching Tool (a matching tool that aligns implementation barriers with tailored strategies for effective change [81]), and the implementation research logic model (a model visualizing relationships between implementation determinants, strategies, mechanisms, and outcomes [82]).

Ethics approval was granted by the University of the Fraser Valley on June 10, 2025, through the BC Provincial Research Ethics Platform as a harmonized review (H25-00347). Recruitment commenced in July 2025 in British Columbia (BC), although exact dates were staggered and differed across hospital and organization sites pending time for relevant administrative reviews and approvals and amendments. Recruitment commenced in September 2025 in Ontario, although exact dates were staggered and varied pending time for administrative reviews and approvals. The Maritime provinces were onboarded on September 24, 2025, and ethics approval was granted by Island Health on March 11, 2026 (1032291). No research procedures occurred at sites prior to securing local approvals and no compensation is being provided to participants.

Research user groups, including patients with and survivors of pediatric cancer or blood disorders, carers, health care providers and staff, and support organization personnel, are being recruited. Multiple approaches are being used to recruit members from each group.

Given the nature of this project, no formal sample size estimate was computed. Rather, targets for each participant group were set based on available data describing new diagnoses in BC, Ontario, and the Maritime provinces yearly [85], the estimated number of health care providers and staff at each site, and the number of known support organizations for pediatric patients with and survivors of cancer and blood disorders and survivors across sites. This information was supplemented with population considerations [86], study aims, guidance for information saturation [87], and existing conventions [88].

Approximately 6 to 12 pediatric patients with cancer and blood disorders and survivors including their carers, 6 to 12 health care providers and staff, and 1 to 2 support organization personnel per province (comprising multiple recruiting sites) are anticipated. These sample sizes are anticipated to be sufficient to ensure varied treatment status, wide age range, both sexes, and considerations for location (urban vs rural for patients, survivors, and carers).

Concurrent to the data collection (ie, descriptive surveys and interviews) described earlier, 1:1 consultations are also being conducted with members of all research user groups in BC, Ontario, and the Maritime provinces who serve in a partner or collaborator role. These consultations provide an opportunity to obtain detailed feedback and engage in discussion on specific components of the IMPACT intervention and trial that are being raised in interviews (eg, intervention content, delivery processes, recruitment, and consenting procedures). Consultations are scheduled at partners’ and collaborators’ convenience and conducted via telephone or videoconference. Each consultation is tailored to the role and expertise of the partner or collaborator and is focused on specific topics or issues, enabling early feedback on data, offering suggestions, and supporting ongoing interpretation. Notes from consultations are documented and integrated with interview data to ensure that patient, survivor, carer, health care provider, and support organization personnel perspectives are informing the co-adaptation process. Finally, additional ancillary consultations are being conducted with Alberta-based carers of patients who participated in IMPACT, as well as clinical and support organization partners. These data are primarily being gathered to inform Alberta-based refinements and plans for sustainability; however, summaries will also be used to supplement data gathered herein and support the co-adaptation of IMPACT in BC, Ontario, and the Maritime provinces.

This research program and specific phase has adopted an integrated knowledge translation approach and has engaged research users as part of the study team from the outset. The involvement of Alberta-based patients, carers, health care providers, and support organization personnel will continue, and additional research users from BC, Ontario, and the Maritime provinces have been identified and involved. New research users were identified through professional and community conferences and workshops, networking with clinical collaborators and support organization partners, referral from existing collaborators, and snowball processes. Research users will continue to be identified as indicated via the same pathways. Current engagement mechanisms include advisory meetings and regular updates and newsletters. Planned engagement mechanisms include surveys and feedback loops and collaborative discussion sessions. Study team member composition includes patients or survivors and carers, health care providers, and support organization personnel, totaling over 35 research users as of January 2026 who are engaged in this work.

Beyond this, the project described herein seeks to capture and center research users’ perspectives via interviews and iterative data collating techniques. This supports developing, implementing, and evaluating PA interventions that are needed and wanted by pediatric patients with and survivors of cancer and blood disorders and those who care for and support them.

We are publishing our process (including this protocol) and intend to share findings via a peer-reviewed publication. We will also share findings via site-specific presentations and will copresent (where possible) with research users at conferences and meetings. Aligned with our integrated knowledge translation approach, we have strong partnerships with research users and intend to collaboratively develop outputs (from peer-reviewed manuscripts to infographics to other dissemination tools) and copresent (ie, researcher and research user partnered presentations). We will deliver presentations (via videoconference and in person), create podcasts, draft media briefs, and leverage social media, and we have developed a website to share findings broadly.

Pediatric cancer, although relatively rare, can have lasting physical, psychological, social, and cognitive effects. Despite the well-documented benefits of PA for this cohort [29-37], including published guidelines urging all children and adolescents diagnosed with cancer to move more [57], and the resultant development of IMPACT in Alberta, there are still several gaps that remain to be addressed. IMPACT, as it was implemented in Alberta, was limited by low enrollment, retention, and adherence rates, hindering the understanding of effectiveness and decisions about scaling and implementation. The proposed work will leverage lessons learned in Alberta and generate vital evidence to support PA evidence–based intervention co-adaptation and sustainable uptake from Alberta to BC, Ontario, and the Maritime provinces, varied regions with unique cancer care systems and PA support available.

Findings will represent a first step toward implementing and evaluating a reimagined IMPACT across Canada. The multisite database covering research user–identified factors influencing implementation across 3 Canadian provinces will directly inform supportive strategies. Outputs from this work will include site-specific implementation strategies, processes, and resources, as well as an implementation research logic model for ongoing scaling and implementation.

The proposed work has several strengths. First, adopting a collaborative approach centering research users’ perspectives will ensure a deeper understanding of real-world constraints. This will inform required modifications and increase the likelihood of identifying the breadth of barriers and facilitators that may support or hinder site-specific IMPACT implementation. Second, the pragmatic and broad enrollment criteria in this phase of work will allow for multiple and diverse perspectives to surface implementation challenges and inform potential strategies so that future implementation efforts are contextually relevant and feasible. This inclusive approach is already highlighting the needs and priorities of patients, survivors, carers, health care providers, and support organization personnel and is directly contributing to a reimagined version of IMPACT with greater potential to reach more young people affected by pediatric cancer. Third, the sample size estimates represent a notable strength and will result in a large dataset that will support exploration of varied experiences within and across provinces and enhance the transferability and credibility of findings. Fourth, using established implementation frameworks and models provides a systematic foundation for identifying barriers, facilitators, and strategies to guide scale-up.

Notwithstanding these strengths, there are also important considerations for the proposed work. First, all the study staff conducting interviews are trainees (at varying levels). This could influence the quality of data obtained or influence rapport building. To mitigate this, all study staff complete the same structured training that includes mock interviews and strategies for establishing rapport and effective probing and have their initial interviews audited to identify areas for improvement. Second, as an early-career investigator, the project lead (first author) is actively developing relationships and seeking to build a rich network comprising varying organizations that serve children and adolescents diagnosed with cancer or blood disorders and their carers. Finally, the study team (including research assistants) are positioned outside of hospital settings, which may present challenges for outreach and recruitment. To address this, the study team are maintaining active communication with health care providers and staff and support organization personnel involved in recruitment. Uniquely, this consideration and positioning also offers a valuable opportunity to establish clear referral pathways and processes that connect families to PA, including the reimagined IMPACT, extending access beyond traditional clinical environments—a key component of this research program.

Overall, this phase, within the broader research program described, represents an important and timely step toward ensuring that more pediatric patients with and survivors of cancer and blood disorders have access to supervised PA. By working together with patients, survivors, carers, health care providers and staff and support organization personnel to understand modifications and site-specific considerations, we will generate practical and transferable insights to guide an implementation research logic model and subsequent implementation and evaluation of the reimagined IMPACT across additional provinces. This work will enhance the likelihood of broader applicability and uptake across varied Canadian contexts.