Background: Lynch syndrome (LS) is an inherited cancer predisposition syndrome conferring an increased risk of colorectal, endometrial and other cancer types. Identifying individuals with LS allows access to cancer risk management strategies proven to reduce cancer incidence and improve survival. The typical pathway to LS diagnosis involves molecular testing of the tumour, referral to genetic counselling and a genetic test. However, LS is underdiagnosed and genetic referral rates are poor. Improving LS referral is complex, and requires multisystem behaviour change. The Hide and Seek Project (‘HaSP’) is a cluster RCT determining the effectiveness of two structured implementation approaches aimed at improving LS tumour testing and referral practices, and is underway at seven Australian hospital networks. An in-depth process evaluation is also being conducted alongside the trial to understand what works, why, in what contexts, and at what costs.
Methods: A trained healthcare professional is leading the following phases at each site: (1) undertake baseline audits, (2) form multidisciplinary Implementation Teams, (3) map testing and referral pathways to identify target behaviours for change, (4) identify barriers to change, (5) generate intervention strategies, (6) support staff to implement interventions and (7) evaluate effectiveness using post-implementation clinical data. Process mapping outcomes will be presented, demonstrating a practical application of implementation science methods to identify practice gaps to target for change. Early process evaluation insights will also be presented.
Conclusions: This trial will compare the effectiveness of two approaches for improving the detection of LS amongst patients with CRC, whilst also advancing understanding of the impact of implementation approaches in complex health systems. Insights gained will guide the development of future interventions to improve LS identification on a larger scale and across different contexts, as well as efforts to address the gap between evidence and practice in the rapidly evolving field of genomic research.