Hide and Seek with Hereditary Cancer: Improving detection of colorectal cancer patients with a high risk of Lynch syndrome

A two-arm parallel randomised control trial (RCT) will be used to test a theory based implementation approach (Theoretical Domains Framework Implementation) against a non-theory based implementation approach to improving identification of Lynch syndrome amongst colorectal cancer patients. At each hospital, a locally employed healthcare professional will be appointed as a paid ‘Implementation Lead’ (IL) at one day per week over a 24-month period to coordinate the implementation approach and to oversee data collection. They will have a professional understanding of the LS patient pathway, and the ability to motivate other LS stakeholders to engage with implementation processes. Each Implementation Lead will participate in a 1-day training seminar by a health psychologist from the CCNSW research team in one of two approaches (theory or non-theory). CIA Taylor developed the following training toolkit and 1-day course: http://www.improvementacademy.org/tools-and-resources/abc-for-patient-safety-toolkit.html. These training materials have been refined for this study and modified according to trial arm. Those in the theory-based trial arm will be trained in the Theoretical Domains Framework Implementation (TDFI) approach. Following training, the Implementation Lead will work through the following steps at their hospital over a 24-month period: 1. Extract baseline audit data: Clinical data from surgical, pathology and FCC databases will be extracted to determine proportion of pts appropriately referred 2. Form Implementation Team: will form a team of 8-10 multidisciplinary staff involved in the LS referral and diagnosis pathway (e.g. genetic counsellors, CRC surgeons, oncologists, pathologists, nurses, admin etc) 3. Map referral process and identify targets for change: 2 x meetings to map current processes and (using audit data) identify areas for change 4. Identify barriers to change: Staff to complete 5 min questionnaire about perceived barriers & focus group to discuss and confirm main barriers (using the theoretical domains framework; TDF) 5. Generate intervention strategies: Second focus group to develop intervention strategies to address main barriers (using the theoretical domains framework; TDF) 6. Implement intervention strategies: Implementation lead (with support from CCNSW) will implement strategies over a 6mo period 7. Evaluate intervention: extract data & compare with baseline to assess change