Comparing theory-driven and intuition-based approaches to inform implementation strategies in practice: an...

Area of Science:

• Implementation Science
• Health Services Research
• Genetics and Genomics

Background:

• Assessing the impact of theory in implementation strategies requires isolating theoretical components.
• Lynch syndrome (LS) is a hereditary cancer predisposition condition.
• Improving risk-appropriate tumor testing and genetics referral is crucial for LS management.

Purpose of the Study:

• To compare theory-driven versus intuition-based approaches for developing implementation strategies.
• To enhance risk-appropriate tumor testing and referral to genetics services for Lynch syndrome.
• To explore the impact of theoretical frameworks on implementation outcomes in a clinical setting.

Main Methods:

• A two-arm cluster-randomized implementation trial involving seven Australian hospitals.
• Intervention arms: theory-driven (using Theoretical Domains Framework and Behavior Change Techniques) vs. intuition-based strategy development.
• Primary outcome: rate of risk-appropriate LS tumor testing and referral post-colorectal cancer resection (n=3,321).

Main Results:

• The theory-driven arm showed a non-significant improvement in the primary outcome (risk-appropriate LS pathway completion).
• Excluding one large hospital revealed a null effect for the primary outcome, indicating heterogeneous results.
• A significant reduction in genetics referrals was observed for high-risk LS patients in the theory-driven arm (secondary outcome).

Conclusions:

• Theory-driven implementation demonstrated stronger improvements in a secondary outcome (genetics referral for high-risk patients).
• Evidence for the primary outcome (overall risk-appropriate pathway completion) was inconclusive.
• The trial design provides a template for isolating and evaluating the contribution of theory to implementation strategies.