||5R01CA211723-03 Interpret this number
||Implementing Universal Lynch Syndrome Screening Across Multiple Healthcare Systems: Identifying Strategies to Facilitate and Maintain Programs in Different Organizational Contexts
Lynch syndrome (LS) is the most common form of inherited colorectal cancer risk. People with
Lynch syndrome are also at increased risk for endometrial, ovarian, gastric, small bowel, and
renal cancers. Importantly, well-established clinical guidelines with strong evidence exist for
cancer treatment, screening, and prevention in individuals with LS. Identification of individuals
with LS is accomplished through a variety of techniques, including family and medical history
evaluation, computational models, or tumor testing. The systematic screening of all colorectal
tumors for LS was first recommended by the Evaluation of Genetic Application in Practice and
Prevention (EGAPP) working group in 2009 and has been designated high priority by the
National Academies of Science, Engineering, and Medicine working group and by the Blue
Ribbon Panel. The potential public health impact to reduce cancer morbidity and mortality of this
intervention supports this priority, as effective implementation of LS screening will help meet the
goals of the Cancer Moonshot as well as demonstrate the promise of precision medicine.
Currently, implementation of LS screening in healthcare systems remains suboptimal for a
variety of reasons. LS screening involves the coordination of multiple departments and
individuals across an organization, which is often difficult in large, complex, healthcare systems.
Therefore, the overarching goal of this project is to utilize tools from implementation science to
describe, explain, and compare decision making and other variations in LS screening
implementation across multiple healthcare systems to create and evaluate in a real world setting
an organizational toolkit to facilitate implementation of LS screening. Our specific aims are to (1)
Describe variation in LS screening implementation across multiple healthcare systems; then (2)
Explain practice variation and determine factors associated with optimal implementation; and (3)
Determine the relative effectiveness, efficiency, and costs of different LS screening protocols by
healthcare system; and finally to (4) Develop and test in a natural environment an organizational
toolkit for LS screening. This toolkit will enable effective implementation of LS screening
programs; ultimately preventing needless suffering of patients and their family members from
preventable cancers, decreasing waste in healthcare system costs, and informing strategies to
facilitate the promise of precision medicine.
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