Improving Lynch syndrome detection: a mixed-methods process evaluation of a hybrid type III...

Area of Science:

• Genomic Medicine
• Implementation Science
• Clinical Trial Methodology

Background:

• Translating evidence-based genomics practices into healthcare is challenging.
• The Hide and Seek Project (HaSP) trial compared theory-based vs. intuition-based implementation strategies for hereditary cancer referrals.
• This process evaluation explored how and why these strategies impacted practice.

Purpose of the Study:

• To provide insights into the mechanisms and contextual factors influencing implementation strategies in genomics.
• To compare the effectiveness of theory-based versus intuition-based implementation approaches.
• To identify determinants of success for hospital-specific implementation strategies.

Main Methods:

• A mixed-methods process evaluation using post-implementation interviews with 18 participants from seven sites.
• Analysis guided by the Consolidated Framework for Implementation Research (CFIR 2.0).
• Triangulation with focus groups, observations, and project logs; development of logic models and case studies.

Main Results:

• Key themes included Lynch syndrome complexity, pandemic disruptions, IT constraints, and multidisciplinary collaboration.
• 39 contextual determinants (barriers/facilitators) across 18 CFIR constructs were identified.
• Theory-based strategies appeared to better support Lynch syndrome detection than intuition-based ones.

Conclusions:

• The process evaluation deepens understanding of factors influencing implementation strategy success in genomics.
• Findings identified pathways to optimize the HaSP implementation approach.
• Theory-based strategies show promise for improving hereditary cancer referral practices.