title: Stakeholder perspectives on implementing a universal Lynch syndrome screening program: a qualitative study of early barriers and facilitators.
abstract: OBJECTIVE
  Evidence-based guidelines recommend that all newly diagnosed colon cancer be screened for Lynch syndrome (LS), but best practices for implementing universal tumor screening have not been extensively studied. We interviewed a range of stakeholders in an integrated health-care system to identify initial factors that might promote or hinder the successful implementation of a universal LS screening program.
  
  
  METHODS
  We conducted interviews with health-plan leaders, managers, and staff. Interviews were audio-recorded and transcribed. Thematic analysis began with a grounded approach and was also guided by the Practical Robust Implementation and Sustainability Model (PRISM).
  
  
  RESULTS
  We completed 14 interviews with leaders/managers and staff representing involved clinical and health-plan departments. Although stakeholders supported the concept of universal screening, they identified several internal (organizational) and external (environment) factors that promote or hinder implementation. Facilitating factors included perceived benefits of screening for patients and organization, collaboration between departments, and availability of organizational resources. Barriers were also identified, including: lack of awareness of guidelines, lack of guideline clarity, staffing and program "ownership" concerns, and cost uncertainties. Analysis also revealed nine important infrastructure-type considerations for successful implementation.
  
  
  CONCLUSIONS
  We found that clinical, laboratory, and administrative departments supported universal tumor screening for LS. Requirements for successful implementation may include interdepartmental collaboration and communication, patient and provider/staff education, and significant infrastructure and resource support related to laboratory processing and systems for electronic ordering and tracking.
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Schneider
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA.
authors.forename: James
authors.initials: J
authors.lastname: Davis
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA.
authors.forename: Tia L
authors.identifier: http://orcid.org/0000-0002-0419-4223
authors.initials: TL
authors.lastname: Kauffman
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA.
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Reiss
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA.
authors.forename: Cheryl
authors.initials: C
authors.lastname: McGinley
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Arnold
authors.affiliation: Northwest Permanente, Kaiser Permanente Northwest, Portland, Oregon, USA.
authors.forename: Jamilyn
authors.initials: J
authors.lastname: Zepp
authors.affiliation: Northwest Permanente, Kaiser Permanente Northwest, Portland, Oregon, USA.
authors.forename: Marian
authors.initials: M
authors.lastname: Gilmore
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA.
authors.forename: Kristin R
authors.identifier: http://orcid.org/0000-0001-9883-2224
authors.initials: KR
authors.lastname: Muessig
authors.affiliation: Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Sapna
authors.initials: S
authors.lastname: Syngal
authors.affiliation: Case Western Reserve University, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
authors.forename: Louise
authors.initials: L
authors.lastname: Acheson
authors.affiliation: Vanderbilt Hereditary Cancer Program, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA.
authors.forename: Georgia L
authors.identifier: http://orcid.org/0000-0001-8897-7008
authors.initials: GL
authors.lastname: Wiesner
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Susan K
authors.initials: SK
authors.lastname: Peterson
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA.
authors.forename: Katrina A B
authors.initials: KA
authors.lastname: Goddard
mesh_terms: D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000175:diagnosis*; D005260:Female; D006285:Health Planning; D006306:Health Surveys; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008403:Mass Screening