Vanessa N Palter1, Natalie A Baker2,3, Linda Rabeneck4, Jill Tinmouth3,5, Anna R Gagliardi6, Erin D Kennedy3,7, June C Carroll3,7, Steven Gallinger3,8, Nancy N Baxter2,3. 1. St. Michael's Hospital, Toronto, ON, Canada. vanessa.palter@mail.utoronto.ca. 2. St. Michael's Hospital, Toronto, ON, Canada. 3. Public Health Sciences, University of Toronto, Toronto, ON, Canada. 4. Cancer Care Ontario, Toronto, ON, Canada. 5. Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 6. Toronto General Research Institute, Toronto, ON, Canada. 7. Mount Sinai Hospital, Toronto, ON, Canada. 8. Department of Surgery, University Health Network, Toronto, ON, Canada.
Abstract
PURPOSE: Lynch syndrome (LS) is the most common inherited cause of colorectal cancer. Although testing all colorectal tumors for LS is recommended, the uptake of reflex-testing programs within health systems has been limited. This multipronged study describes the design of a provincial program for reflex testing in Ontario, Canada. METHODS: We recruited key stakeholders to participate in qualitative interviews to explore the barriers and facilitators to the implementation of a reflex-testing program. Data were analyzed in an iterative manner, key themes identified, and a framework for a proposed program developed. RESULTS: Twenty-six key informants participated in our interviews, and several themes were identified. These included providing education for stakeholders (patients, primary care providers, surgeons); challenges with sustaining various resources (laboratory costs, increased workload for pathologists); ensuring consistency of reporting test results; and developing a plan to measure program success. Using these themes, a framework for the reflex-testing program was developed. At a subsequent stakeholder meeting, the framework was refined, and recommendations were identified. CONCLUSIONS: This study identifies factors to ensure the effective implementation of a population-level program for reflex LS testing. The final product is a prototype that can be utilized in other jurisdictions, taking into account local environmental considerations.
PURPOSE: Lynch syndrome (LS) is the most common inherited cause of colorectal cancer. Although testing all colorectal tumors for LS is recommended, the uptake of reflex-testing programs within health systems has been limited. This multipronged study describes the design of a provincial program for reflex testing in Ontario, Canada. METHODS: We recruited key stakeholders to participate in qualitative interviews to explore the barriers and facilitators to the implementation of a reflex-testing program. Data were analyzed in an iterative manner, key themes identified, and a framework for a proposed program developed. RESULTS: Twenty-six key informants participated in our interviews, and several themes were identified. These included providing education for stakeholders (patients, primary care providers, surgeons); challenges with sustaining various resources (laboratory costs, increased workload for pathologists); ensuring consistency of reporting test results; and developing a plan to measure program success. Using these themes, a framework for the reflex-testing program was developed. At a subsequent stakeholder meeting, the framework was refined, and recommendations were identified. CONCLUSIONS: This study identifies factors to ensure the effective implementation of a population-level program for reflex LS testing. The final product is a prototype that can be utilized in other jurisdictions, taking into account local environmental considerations.
Entities:
Keywords:
Lynch syndrome; cancer prevention; reflex testing; screening
Authors: Elisabeth F P Peterse; Steffie K Naber; Corinne Daly; Aaron Pollett; Lawrence F Paszat; Manon C W Spaander; Melyssa Aronson; Robert Gryfe; Linda Rabeneck; Iris Lansdorp-Vogelaar; Nancy N Baxter Journal: Clin Gastroenterol Hepatol Date: 2019-10-17 Impact factor: 11.382
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