Background <p>As part of a pragmatic cluster-randomized trial for patients with cancer, we recruited representatives from each care setting and trained them to be practice facilitators (“Symptom Sages”). This mixed methods study evaluated barriers and facilitators individuals encountered in this role.</p> Methods <p>Symptom Sages were invited to complete a brief web-based survey and semi-structured interview, developed using constructs from the Consolidated Framework for Implementation Research (CFIR) 2.0. Survey responses were summarized descriptively. Two researchers coded interview transcripts to CFIR 2.0 constructs, reviewed coded text, and created memos to identify themes. Final themes were agreed on via discussion.</p> Results <p>Between August and November 2023, 12 practice facilitators participated (11 completed surveys and 7 completed interviews). Interviews revealed the following themes: 1) training and knowledge acquisition for the facilitator role were sufficient but time was not, 2) mixed perceptions of the intervention and inability to modify the intervention impacted role motivation, and 3) there were challenges motivating colleagues and getting organizational support. Survey results revealed similar findings.</p> Conclusion <p>Training alone is insufficient for practice facilitators’ success in the absence of allocated protected time. Additional implementation strategies may be needed to support adoption in oncology settings.</p> Trial registration <p>This trial was registered at ClinicalTrials.gov, NCT03892967, on March 25, 2019, <a href="https://clinicaltrials.gov/study/NCT03892967">https://clinicaltrials.gov/study/NCT03892967</a>. </p>