Optimising the mainstreaming of renal genomics: Complementing empirical and theoretical strategies for implementation

To identify and develop complementary implementation strategies that support nephrologists in mainstreaming renal genomic testing. Interviews were conducted with individuals nominated as 'genomics champions' and 'embedded genomics experts' as part of a mainstreaming project to identify initial barriers and investigate empirical strategies for delivering the project at initial stage. Data were mapped onto implementation science framework to identify complementary theoretical strategies. Interviews with 14 genomics champions and embedded genomics experts (genetic counsellors, nephrologists, renal nurses), identified 34 barriers to incorporating genomic testing into routine care, e.g., lack of long-term multidisciplinary team support and role clarity. In total, 25 empirical implementation strategies were identified such as creating new clinical teams. Using the Consolidated Framework for Implementation Research, 10 complementary theoretical implementation strategies were identified. Our study presents a novel approach complementing empirical strategies with theoretical strategies to support nephrologists in incorporating genomic testing into routine practice. Complementary strategies can potentially address barriers and inform future studies when mainstreaming renal genomics. This process underscored the need for integrating collaborative efforts among health professionals, patients, implementation scientists and the health system to overcome identified challenges to mainstream genomic testing. Future research should explore the applicability of these strategies to support mainstreaming genomic testing in different clinical settings.