N43: Hide And Seek With Hereditary Cancer: Testing The Effectiveness And Cost-Effectiveness Of Implementation Approaches For Translating Lynch Syndrome Evidence Into Practice

N. Taylor1, A. Morrow1, E. Hogden1, Y. J. Kang1, J. Steinberg1, K. Canfell1, M. Solomon2, J. Kench2, A. Gill3, T. Shaw10, N. Pachter4, B. Parkinson5, L. Wolfenden6, G. Mitchell7, F. Macrae8, K. Tucker9

1 – Cancer Research Division, Cancer Council NSW, Sydney, New south Wales, Australia. 2 – Royal Prince Alfred Hospital, Sydney, NSW, Australia. 3 – Royal North Shore Hospital, Sydney, NSW. 4 – Genetic Services of Western Australia, Australia. 5 – Macquarie University, Sydney, Australia. 6 – Newcastle University, Newcastle, Australia. 7 – University of British Columbia, Vancouver, Canada. 8 – Royal Melbourne Hospital, Melbourne, Australia. 9 – Prince of Wales Hospital, Sydney, Australia. 10 – University of Sydney, Australia.


Aim: Evidence indicates that hospitals face infrastructural, psychosocial and environmental barriers to detecting Lynch Syndrome (LS) patients. In Australia, less than half of all high-risk colorectal cancer (CRC) patients are being referred for LS genetic testing. This study aims to compare the effectiveness and cost-effectiveness of two implementation approaches for increasing the proportion of CRC patients with risk-appropriate completion of the LS testing and referral pathway.

Method: This randomised controlled trial will test the Theoretical Domains Framework Implementation approach against a non-theory-based implementation approach in eight large Australian hospitals. Site based healthcare professionals will be trained to lead the following process: 1) Baseline audits, 2) Form Implementation Teams, 3) Identify practice change behaviours, 4) Identify/confirm barriers to change, 5) Generate intervention strategies, 6) Support intervention implementation, 7) Evaluate practice/culture change. Theoretical and non-theoretical components are distinguished in 4-5.

Results: Progress to date of baseline data analysis will be presented. Plans for the analysis of health and economic outcomes of each implementation approach to be estimated using “POLICY1-Lynch” will be provided.

Conclusion: This will be a world first study to compare theory-based and non-theory based approaches to evidence translation in healthcare, and to incorporate these findings into existing microsimulation models to accurately assess implementation cost-effectiveness.