Defining Codes Based on the Consolidated Framework for Implementation Research in the Context of the Implementing Universal Lynch Syndrome Screening

Lynch syndrome (LS) is the most common hereditary cause of both colorectal cancer (CRC) and endometrial cancer (EC). Universal tumor screening (UTS) of newly diagnosed EC and CRC patients has been shown to be both an effective and economical approach to identify patients with LS and subsequently reduce future cancer s for patients and their family members. Despite its efficacy, LS UTS has not been consistently adopted across hospital systems and existing programs vary widely in their structure and execution. The Implementing Universal Lynch Syndrome Screening (IMPULSS) study aims to determine the critical factors necessary for successful implementation of LS UTS. To that end, semi-structured interviews were conducted with 43 individuals involved in LS UTS (“stakeholders”) across eight different healthcare systems which were divided into 13 analytical units (AUs) Interview transcripts were coded based on constructs from the Consolidated Framework for Implementation Research (CFIR). Interviews from individuals within each hospital system were summarized into a data matrix. In total we analyzed 13 unique programs within the 8 systems, 10 of which had implemented LS UTS. Two coders independently determined whether statements were positive, negative, or neutral regarding the implementation or maintenance of LS UTS program. initial analysis of the coded information reveals that 20 CFIR constructs accounted for over 90% of all coded statements, with the 6 most-used codes accounting for over 50% of coded statements. Initial analysis also showed that major characteristics contributing to LS UTS implementation include having an implementation champion, stakeholder understanding of LS and/or UTS, and stakeholders holding positive beliefs and attitudes regarding the supporting evidence or relative advantage of UTS. Constructs that seemed to impact optimization or program maintenance included evaluation and tracking of the system, the strength and quality of communication between departments, and on-going stakeholder engagement. These constructs were often absent or negatively coded for the AUs that had not implemented tumor screening. We conclude that although CFIR is an effective and comprehensive research framework for analyzing LS UTS, relatively few constructs appear to make a clear difference in implementation and program optimization across these AUs