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Implementing Universal Lynch Syndrome Screening: A Qualitative Analysis of Organizational Stakeholder Interviews

Stafford, Amber (2022) Implementing Universal Lynch Syndrome Screening: A Qualitative Analysis of Organizational Stakeholder Interviews. Master Essay, University of Pittsburgh.

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Lynch syndrome accounts for 3-5% of all newly diagnosed colorectal cancer cases. Numerous clinical guidelines recommend universal tumor screening of all newly diagnosed colorectal cancer patients for Lynch syndrome, and it has become the standard of care; however, some organizations have not yet implemented universal Lynch syndrome screening programs. Universal screening holds public health significance because it increases the detection of Lynch syndrome, allows for cascade testing of at-risk family members, and enables cancer surveillance and prevention which leads to reduced morbidity and mortality. The IMPULSS study aims to understand the variability in implementation, promote the implementation of Lynch syndrome screening at healthcare organizations, and encourage maintenance and evolution of existing screening programs through organizational toolkits based on the needs of organizational implementers and decision makers.

Team members of the IMPULSS study designed an economic modeling tool that allowed stakeholders from various healthcare organizations to understand the costs of LS screening protocols to their organization and to compare the costs of other protocols. Participants who used the tool were involved in the screening process and were interviewed by a study member to discuss their experience using the tool. Transcripts of the interviews were analyzed to help identify factors that affect the decision-making process of stakeholders involved with implementation.

Analysis of the transcripts showed that there are three thematic groups, which include “institutional characteristics”, “personnel characteristics”, and “informing decision-making.” At the institutional level, costs, detection of cases, and adherence to clinical guidelines were prioritized when considering protocol implementation. Participants mentioned a common barrier to protocol implementation buy-in is the likelihood of increased testing volume, and participants identified organizational infrastructure as a common facilitator. At the personnel level, benefit to the patients was prioritized and participants shared that their networks and communication with other stakeholders were important to successful implementation. Within the decision-making process, participants considered costs, compared their current programs to ideal patient care scenarios, and checked other protocol options. Several participants expressed interest in direct-to-germline sequencing. The results from this paper will be used to inform the “deciding to implement” toolkit that will be created by the IMPULSS study.


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Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Stafford, Amberams707@pitt.eduams707
ContributionContributors NameEmailPitt UsernameORCID
Thesis advisorDurst, Andreaadurst@pitt.eduadurstUNSPECIFIED
Committee MemberKulchak Rahm, Alannaakrahm@geisinger.eduUNSPECIFIEDUNSPECIFIED
Committee MemberMai, Phuongmaip@upmc.eduUNSPECIFIEDUNSPECIFIED
Committee MemberSalvati, Zacharyzsalvati@geisinger.eduUNSPECIFIEDUNSPECIFIED
Date: 17 May 2022
Date Type: Completion
Submission Date: 29 April 2022
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 58
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Public Health Genetics
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Uncontrolled Keywords: N/A
Date Deposited: 17 May 2022 16:52
Last Modified: 17 May 2022 16:52


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