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Genet Med. 2018 Oct 22. doi: 10.1038/s41436-018-0342-8. [Epub ahead of print]

A framework to build capacity for a reflex-testing program for Lynch syndrome.

Author information

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.

KEYWORDS:

Lynch syndrome; cancer prevention; reflex testing; screening

PMID:
30349099
DOI:
10.1038/s41436-018-0342-8

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