title: Barriers and Facilitators to Adoption of Genomic Services for Colorectal Care within the Veterans Health Administration.
abstract: We examined facilitators and barriers to adoption of genomic services for colorectal care, one of the first genomic medicine applications, within the Veterans Health Administration to shed light on areas for practice change. We conducted semi-structured interviews with 58 clinicians to understand use of the following genomic services for colorectal care: family health history documentation, molecular and genetic testing, and genetic counseling. Data collection and analysis were informed by two conceptual frameworks, the Greenhalgh Diffusion of Innovation and Andersen Behavioral Model, to allow for concurrent examination of both access and innovation factors. Specialists were more likely than primary care clinicians to obtain family history to investigate hereditary colorectal cancer (CRC), but with limited detail; clinicians suggested templates to facilitate retrieval and documentation of family history according to guidelines. Clinicians identified advantage of molecular tumor analysis prior to genetic testing, but tumor testing was infrequently used due to perceived low disease burden. Support from genetic counselors was regarded as facilitative for considering hereditary basis of CRC diagnosis, but there was variability in awareness of and access to this expertise. Our data suggest the need for tools and policies to establish and disseminate well-defined processes for accessing services and adhering to guidelines.
authors.affiliation: Center for Health Services Research in Primary Care, Health Services Research &amp; Development Service, 411 West Chapel Hill Street, Suite 600, Durham, NC 27701, USA. nina.sperber@va.gov.|Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, 411 West Chapel Hill Street, Suite 500, Durham, NC 27701, USA. nina.sperber@va.gov.
authors.forename: Nina R
authors.initials: NR
authors.lastname: Sperber
authors.affiliation: Center for Health Services Research in Primary Care, Health Services Research &amp; Development Service, 411 West Chapel Hill Street, Suite 600, Durham, NC 27701, USA. Sara.Andrews@va.gov.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Andrews
authors.affiliation: Center for Health Services Research in Primary Care, Health Services Research &amp; Development Service, 411 West Chapel Hill Street, Suite 600, Durham, NC 27701, USA. corrine.voils@dm.duke.edu.|Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, 411 West Chapel Hill Street, Suite 500, Durham, NC 27701, USA. corrine.voils@dm.duke.edu.
authors.forename: Corrine I
authors.initials: CI
authors.lastname: Voils
authors.affiliation: VAMC, 4150 Clement Street, San Francisco, CA 94121, USA. gregory.green@va.gov.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Green
authors.affiliation: Department of Veterans Affairs, Cooperative Studies Program Epidemiology Center, 411 West Chapel Hill Street, Suite 600, Durham, NC 27701, USA. dawn.provenzale@va.gov.
authors.forename: Dawn
authors.initials: D
authors.lastname: Provenzale
authors.affiliation: Health Services Research &amp; Development Service, 700 S. 19th Street, Birmingham, AL 35233, USA. sara.knight@va.gov.|Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, MT 638, 1720 2nd Avenue South, Birmingham, AL 35294, USA. sara.knight@va.gov.
authors.forename: Sara
authors.initials: S
authors.lastname: Knight
keywords: Lynch syndrome; implementation research; qualitative methods