Using behaviour change and implementation science to address low referral rates in oncology 11 Medical and Health Sciences 1117 Public Health and Health Services

Long, JC; Debono, D; Williams, R; Salisbury, E; O'Neill, S; Eykman, E; Butler, J; Rawson, R; Phan-Thien, KC; Thompson, SR; Braithwaite, J; Chin, M; Taylor, N

Using behaviour change and implementation science to address low referral rates in oncology 11 Medical and Health Sciences 1117 Public Health and Health Services

Williams, R Salisbury, E O'Neill, S Eykman, E Butler, J Rawson, R Phan-Thien, KC Thompson, SR Braithwaite, J Chin, M Taylor, N

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Publication Type:: Journal Article
Citation:: BMC Health Services Research, 2018, 18 (1)
Issue Date:: 2018-11-28

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Field	Value	Language
dc.contributor.author	Long, JC https://orcid.org/0000-0002-0553-682X	en_US
dc.contributor.author	Debono, D https://orcid.org/0000-0003-2095-156X	en_US
dc.contributor.author	Williams, R	en_US
dc.contributor.author	Salisbury, E	en_US
dc.contributor.author	O'Neill, S	en_US
dc.contributor.author	Eykman, E	en_US
dc.contributor.author	Butler, J	en_US
dc.contributor.author	Rawson, R	en_US
dc.contributor.author	Phan-Thien, KC	en_US
dc.contributor.author	Thompson, SR	en_US
dc.contributor.author	Braithwaite, J	en_US
dc.contributor.author	Chin, M	en_US
dc.contributor.author	Taylor, N	en_US
dc.date.available	2018-10-26	en_US
dc.date.issued	2018-11-28	en_US
dc.identifier.citation	BMC Health Services Research, 2018, 18 (1)	en_US
dc.identifier.uri	http://hdl.handle.net/10453/129949
dc.description.abstract	© 2018 The Author(s). Background: Patients undergoing surgery for bowel cancer now have a routine screening test to assess their genetic predisposition to this and other cancers (Lynch syndrome). A result indicating a high risk should trigger referral to a genetic clinic for diagnostic testing, information, and management. Appropriate management of Lynch syndrome lowers morbidity and mortality from cancer for patients and their family, but referral rates are low. The aim of this project was to increase referral rates for patients at high risk of Lynch syndrome at two Australian hospitals, using the Theoretical Domains Framework (TDF) Implementation approach. Methods: Multidisciplinary teams at each hospital mapped the referral process and discussed barriers to referral. A 12-month retrospective audit measured baseline referral rates. The validated Influences on Patient Safety Behaviours Questionnaire was administered to evaluate barriers using the TDF. Results were discussed in focus groups and interviews, and interventions co-designed, guided by theory. Continuous monitoring audits assessed change in referral rates. Results: Teams (n = 8, 11) at each hospital mapped referral processes. Baseline referral rates were 80% (4/5) from 71 screened patients and 8% (1/14) from 113 patients respectively. The questionnaire response rate was 51% (36/71). Most significant barrier domains were: 'environmental context;' 'memory and decision making;' 'skills;' and 'beliefs about capabilities.' Focus groups and interviews with 19 healthcare professionals confirmed these domains as significant. Fifteen interventions were proposed considering both emerging and theory-based results. Interventions included: clarification of pathology reports, education, introduction of e-referrals, and inclusion of genetic status in documentation. Audits continued to December 2016 showing a change in pathology processes which increased the accuracy of screening. The referral rate remained low: 46% at Hospital A and 9% Hospital B. Results suggest patients who have their referral deferred for some reason are not referred later. Conclusion: Lynch syndrome is typical of low incidence problems likely to overwhelm the system as genomic testing becomes mainstream. It is crucial for health researchers to test methods and define generalizable solutions to address this problem. Whilst our approach did not improve referrals, we have deepened our understanding of barriers to referral and approaches to low frequency conditions.	en_US
dc.relation.ispartof	BMC Health Services Research	en_US
dc.relation.isbasedon	10.1186/s12913-018-3653-1	en_US
dc.subject.classification	Health Policy & Services	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Colorectal Neoplasms, Hereditary Nonpolyposis	en_US
dc.subject.mesh	Focus Groups	en_US
dc.subject.mesh	Retrospective Studies	en_US
dc.subject.mesh	Decision Making	en_US
dc.subject.mesh	Medical Oncology	en_US
dc.subject.mesh	Health Personnel	en_US
dc.subject.mesh	Hospitals	en_US
dc.subject.mesh	Referral and Consultation	en_US
dc.subject.mesh	Australia	en_US
dc.subject.mesh	Early Detection of Cancer	en_US
dc.subject.mesh	Patient Safety	en_US
dc.subject.mesh	Surveys and Questionnaires	en_US
dc.subject.mesh	Implementation Science	en_US
dc.subject.mesh	Facilities and Services Utilization	en_US
dc.title	Using behaviour change and implementation science to address low referral rates in oncology 11 Medical and Health Sciences 1117 Public Health and Health Services	en_US
dc.type	Journal Article
utslib.citation.volume	1	en_US
utslib.citation.volume	18	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	0807 Library and Information Studies	en_US
utslib.for	1110 Nursing	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
utslib.copyright.status	open_access
pubs.issue	1	en_US
pubs.publication-status	Published	en_US
pubs.volume	18	en_US

Abstract:

© 2018 The Author(s). Background: Patients undergoing surgery for bowel cancer now have a routine screening test to assess their genetic predisposition to this and other cancers (Lynch syndrome). A result indicating a high risk should trigger referral to a genetic clinic for diagnostic testing, information, and management. Appropriate management of Lynch syndrome lowers morbidity and mortality from cancer for patients and their family, but referral rates are low. The aim of this project was to increase referral rates for patients at high risk of Lynch syndrome at two Australian hospitals, using the Theoretical Domains Framework (TDF) Implementation approach. Methods: Multidisciplinary teams at each hospital mapped the referral process and discussed barriers to referral. A 12-month retrospective audit measured baseline referral rates. The validated Influences on Patient Safety Behaviours Questionnaire was administered to evaluate barriers using the TDF. Results were discussed in focus groups and interviews, and interventions co-designed, guided by theory. Continuous monitoring audits assessed change in referral rates. Results: Teams (n = 8, 11) at each hospital mapped referral processes. Baseline referral rates were 80% (4/5) from 71 screened patients and 8% (1/14) from 113 patients respectively. The questionnaire response rate was 51% (36/71). Most significant barrier domains were: 'environmental context;' 'memory and decision making;' 'skills;' and 'beliefs about capabilities.' Focus groups and interviews with 19 healthcare professionals confirmed these domains as significant. Fifteen interventions were proposed considering both emerging and theory-based results. Interventions included: clarification of pathology reports, education, introduction of e-referrals, and inclusion of genetic status in documentation. Audits continued to December 2016 showing a change in pathology processes which increased the accuracy of screening. The referral rate remained low: 46% at Hospital A and 9% Hospital B. Results suggest patients who have their referral deferred for some reason are not referred later. Conclusion: Lynch syndrome is typical of low incidence problems likely to overwhelm the system as genomic testing becomes mainstream. It is crucial for health researchers to test methods and define generalizable solutions to address this problem. Whilst our approach did not improve referrals, we have deepened our understanding of barriers to referral and approaches to low frequency conditions.

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http://hdl.handle.net/10453/129949