title: Comparing universal Lynch syndrome tumor-screening programs to evaluate associations between implementation strategies and patient follow-through.
abstract: OBJECTIVE
  Universal tumor screening (UTS) for all colorectal cancer patients can improve the identification of Lynch syndrome, the most common cause of hereditary colorectal cancer. This multiple-case study explored how variability in UTS procedures influenced patient follow-through (PF) with germ-line testing after a screen-positive result.
  
  
  METHODS
  Data were obtained through Web-based surveys and telephone interviews with institutional informants. Institutions were categorized as Low-PF (≤10% underwent germ-line testing), Medium-PF (11-40%), or High-PF (>40%). To identify implementation procedures (i.e., conditions) unique to High-PF institutions, qualitative comparative analysis was performed.
  
  
  RESULTS
  Twenty-one informants from 15 institutions completed surveys and/or interviews. Conditions present among all five High-PF institutions included the following: (i) disclosure of screen-positive results to patients by genetic counselors; and (ii) genetic counselors either facilitate physician referrals to genetics professionals or eliminate the need for referrals. Although both of these High-PF conditions were present among two Medium-PF institutions, automatic reflex testing was lacking and difficulty contacting screen-positive patients was a barrier. The three remaining Medium-PF and five Low-PF institutions lacked the conditions found in High-PF institutions.
  
  
  CONCLUSIONS
  METHODS for streamlining UTS procedures, incorporating a high level of involvement of genetic counselors in tracking and communication of results and in reducing barriers to patient contact, are reviewed within a broader discussion on maximizing the effectiveness and public health impact of UTS.
authors.affiliation: Division of Population Science, Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Cragun
authors.affiliation: Department of Community and Family Health, University of South Florida, Tampa, Florida, USA.
authors.forename: Rita D
authors.initials: RD
authors.lastname: DeBate
authors.affiliation: Division of Population Science, Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Susan T
authors.initials: ST
authors.lastname: Vadaparampil
authors.affiliation: Department of Community and Family Health, University of South Florida, Tampa, Florida, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Baldwin
authors.affiliation: Department of Internal Medicine, Ohio State University, Columbus, Ohio, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Hampel
authors.affiliation: Division of Population Science, Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Tuya
authors.initials: T
authors.lastname: Pal
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000235:genetics; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000175:diagnosis* / Q000235:genetics; D055088:Early Detection of Cancer / Q000379:methods / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D005817:Genetic Counseling / Q000379:methods / Q000706:statistics & numerical data; D005820:Genetic Testing / Q000379:methods* / Q000706:statistics & numerical data; D018095:Germ-Line Mutation; D006306:Health Surveys / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity