Table 2 Paired and unpaired themes across facility adherence status by Conceptual Framework of Implementation Fidelity domains

Intervention Complexity

• Intervention was simply designed (high and low)

Participant Responsiveness

• Patients and families often changed advance directives after viewing the video (high and low)

• Patients and families were open (high) vs. reluctant (low) to view the video

• ACP video program is useful only on an as-needed basis (low)

• Champions have personal investment in ACP (high)

Recruitment

• Champion’s efforts to recruit patients and families were strategic (high) vs. tentative (low)

Quality of Delivery

• Champions actively combined showing the video with an ACP conversation (high)

Context

• Facilities had resource challenges (low)

• Facilities had pre-existing ACP processes (low)

• Facilities challenged by their ACP processes would benefit from the ACP video program (high)

Strategies to Facilitate Implementation

• Champions felt confident in their role (high) vs. not (low)

• Research team facilitation was helpful (high)