Comparing theory and non-theory based implementation approaches to improving referral practices in cancer genetics: a cluster randomised trial protocol

• DOI: 10.1186/s13063-019-3457-6
• Publication Date: 2019-06-20T10:02:46Z
• Authors: April Morrow; Emily Hogden; Yoon-Jung Kang; Julia Steinberg; Karen Canfell; Michael J. Solomon; James G. Kench; Anthony J. Gill; Tim Shaw; Nicholas Pachter; Bonny Parkinson; Luke Wolfenden; Gillian Mitchell; Finlay Macrae; Kathy Tucker; Natalie Taylor
• Keywords: Medicine (General); Early Detection, Diagnosis, and Prognosis - Resources and Infrastructure; 610; 613; Theoretical domains framework; Study Protocol; 03 medical and health sciences; R5-920; 0302 clinical medicine; Diagnosis; Outcome Assessment, Health Care; Early Detection; Humans; Referral and Consultation; Randomized Controlled Trials as Topic; 380; Behaviour change; Colorectal Neoplasms, Hereditary Nonpolyposis; Hereditary cancer; 3. Good health; and Prognosis - Resources and Infrastructure; Lynch syndrome; Implementation; Colorectal Neoplasms

Lynch syndrome (LS) is an inherited, cancer predisposition associated with increased risk of colorectal, endometrial and other types. Identifying individuals LS allows access to management strategies proven reduce incidence improve survival. However, underdiagnosed genetic referral rates are poor. Improving complex, requires multisystem behaviour change. Although barriers have been identified, evidence-based facilitate change lacking. The aim this study compare the effectiveness a theory-based implementation approach against non-theory based for improving detection amongst Australian patients colorectal (CRC). A two-arm parallel cluster randomised trial design will be used two identical, structured approaches, distinguished only by use theory identify targeted intervention strategies, practices in eight large hospital networks. Each network randomly allocated arm, stratification state. trained healthcare professional lead following phases at each site: (1) undertake baseline clinical practice audits, (2) form multidisciplinary Implementation Teams, (3) target behaviours change, (4) (5) generate (6) support staff implement interventions (7) evaluate using post-implementation data. theoretical non-theoretical components arm 4–5. Study outcomes include process map network, evaluation proportion risk-appropriate completion pathway within 2 months CRC resection pre post implementation. This determine more effective CRC, whilst also advancing understanding impact approaches complex health systems feasibility training professionals them. Insights gained guide development future identification on larger scale across different contexts, as well efforts address gap between evidence rapidly evolving field genomic research. ANZCTR, ACTRN12618001072202 . Registered 27 June 2018.