Oral Presentation COSA 2015 ASM

Achieving healthcare professional behaviour change for detection and management of Lynch syndrome (#131)

Natalie Taylor 1 2 , Rachel Williams 2 3 , Deborah Debono 1 2 , Melvin Chin 2 3 , Janet Long 2 4 , Elizabeth Salisbury 2 5 , Jordan Butler 2 5 , Mary Potter 2 , Sharron O'Neill 6 , Jeffrey Braithwaite 1 2
  1. Australian Institute of Health Innovation, Macquarie University, Sydney
  2. Translational Cancer Research Network, Sydney
  3. Prince of Wales Hospital, Sydney
  4. Macquarie University, Macquarie Park, ACT, Australia
  5. SEALS Pathology, Sydney
  6. IGAP Research Centre, Macquarie University, Sydney

Aims: Lynch syndrome is an inherited disorder associated with a range of cancers and is found in 2-5% of colorectal cancers.1,2 It is diagnosed using a definitive genetic test. If identified early, carriers can undergo increased surveillance for cancers, allowing for prevention and/or better management of cancer for patients and their relatives.3 Globally, evidence indicates that only a small proportion of individuals with suspected Lynch syndrome are being referred for genetic testing. This project uses behaviour change theory and implementation science to improve the referral process for colorectal cancer patients with a high likelihood risk of Lynch syndrome into genetic diagnostic services.

Methods: The six-step validated Theoretical Domains Framework Implementation (TDFI) approach4 is being applied at two large, Australian metropolitan hospitals. Steps are: 1. Form local multidisciplinary teams to map current processes. 2. Identify target behaviours for change using discussion and retrospective audit. 3. Identify barriers to change using a validated questionnaire. 4. Confirm and address barriers using co-designed strategies. 5. Support implementation. 6. Evaluate intervention impact. The difference in the proportion of high-likelihood risk Lynch syndrome patients being referred for genetic testing, and changes in the mean-time from pathology test results to referral will be assessed using Chi square and paired t-test analyses, respectively. Scheduled monthly audits will generate run charts to continuously monitor change in referrals over time.

Results: Steps 1 and 2 of the TDFI approach are underway. Stakeholders are informing the design of a referrals process map. Algorithms have been created to match referral data patterns to the process map to identify the target behaviour for change.

Conclusions: This project is based on a tested and refined implementation strategy. Improving the accuracy of referrals for genetic counselling will optimise treatment and reduce mortality for patients and their relatives.

  1. Lynch H, Paulson J, Severin M, et al. Failure to diagnose hereditary colorectal cancer and its medicolegal implications. Diseases in the Colon and Rectum 1999;42(1):31-35.
  2. Dinh TA, Rosner BI, Atwood JC, et al. Health benefits and cost-effectiveness of primary genetic screening for Lynch Syndrome in the general population. Cancer Prevention Research 2011;4(1):9-22.
  3. Frayling I, Ward R. Should we consider introducing systematic screening for Lynch Syndrome? Cancer Forum 2014;38(3):229-32.
  4. Taylor N, Lawton R, Moore S, et al. Collaborating with front-line healthcare professionals: the clinical and cost effectiveness of a theory based approach to the implementation of a national guideline. BMC Health Services Research 2014;14(1):1-10.