This preprint is under consideration at Implementation Science. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Shakira Milton
The University of Melbourne
Corresponding Author
ORCiD: https://orcid.org/0000-0002-8510-6351
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
We developed a colorectal cancer risk prediction tool (‘CRISP’) to provide individualised risk-based advice for colorectal cancer screening. Using known environmental, behavioural, and familial risk factors, CRISP was designed to facilitate tailored screening advice to patients aged 50 to 74 years in general practice. In parallel to a randomised controlled trial of the CRISP tool, we developed and evaluated an evidence-based implementation strategy.
Methods
Qualitative methods were used to explore the implementation of CRISP in general practice. Using one general practice in regional Victoria, Australia as a ‘laboratory’, we tested ways to embed CRISP into routine clinical practice. General practitioners, nurses, and a practice manager co-designed the implementation methods with researchers, focussing on existing practice processes that would be sustainable. Researchers interviewed the staff regularly to assess the successfulness of the strategies employed, and implementation methods were adapted throughout the study period in response to feedback from qualitative interviews.
The Consolidated Framework for Implementation Research (CFIR) underpinned the development of the interview guide and intervention strategy. Coding was inductive and themes were developed through consensus between the authors. Emerging themes were mapped onto the CFIR domains and a fidelity checklist was developed to ensure CRISP was being used as intended.
Results
Between December 2016 and September 2019, eleven interviews were conducted, both face-to-face and via videoconferencing (Zoom). All interviews were transcribed verbatim and coded. Themes were mapped onto the following CFIR domains: 1. ‘characteristics of the intervention’: CRISP was valued but time consuming; 2. ‘inner setting’: the practice was open to changing systems; 3. ‘outer setting’: CRISP helped facilitate screening; 4. ‘individual characteristics’: the practice staff were adaptable and able to facilitate adoption of new clinical processes; and 5. ‘processes’: fidelity checking and education was important.
Conclusions
These results describe a novel method for exploring implementation strategies for a colorectal cancer risk prediction tool in the context of a parallel RCT testing clinical efficacy. The study identified successful and unsuccessful implementation strategies using an adaptive methodology over time. This method emphasised the importance of co-design input to make an intervention like CRISP sustainable for use in other practices and with other risk tools.
Trial registration
N/A
Keywords
Colorectal cancer screening, general practice, primary care, risk prediction tool, implementation science
Figure 1
Figure 2
This is a list of supplementary files associated with this preprint. Click to download.
Loading...
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 15 Nov, 2021
No community comments so far
Reviewers invited
Invitations sent on 29 Nov, 2021
Editor assigned
On 08 Nov, 2021
Submission checks complete
On 07 Nov, 2021
Editor invited
On 07 Nov, 2021
First submitted
On 03 Nov, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Learn more about our company.
This preprint is under consideration at Implementation Science. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Shakira Milton
The University of Melbourne
Corresponding Author
ORCiD: https://orcid.org/0000-0002-8510-6351
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 15 Nov, 2021
No community comments so far
Reviewers invited
Invitations sent on 29 Nov, 2021
Editor assigned
On 08 Nov, 2021
Submission checks complete
On 07 Nov, 2021
Editor invited
On 07 Nov, 2021
First submitted
On 03 Nov, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
We developed a colorectal cancer risk prediction tool (‘CRISP’) to provide individualised risk-based advice for colorectal cancer screening. Using known environmental, behavioural, and familial risk factors, CRISP was designed to facilitate tailored screening advice to patients aged 50 to 74 years in general practice. In parallel to a randomised controlled trial of the CRISP tool, we developed and evaluated an evidence-based implementation strategy.
Methods
Qualitative methods were used to explore the implementation of CRISP in general practice. Using one general practice in regional Victoria, Australia as a ‘laboratory’, we tested ways to embed CRISP into routine clinical practice. General practitioners, nurses, and a practice manager co-designed the implementation methods with researchers, focussing on existing practice processes that would be sustainable. Researchers interviewed the staff regularly to assess the successfulness of the strategies employed, and implementation methods were adapted throughout the study period in response to feedback from qualitative interviews.
The Consolidated Framework for Implementation Research (CFIR) underpinned the development of the interview guide and intervention strategy. Coding was inductive and themes were developed through consensus between the authors. Emerging themes were mapped onto the CFIR domains and a fidelity checklist was developed to ensure CRISP was being used as intended.
Results
Between December 2016 and September 2019, eleven interviews were conducted, both face-to-face and via videoconferencing (Zoom). All interviews were transcribed verbatim and coded. Themes were mapped onto the following CFIR domains: 1. ‘characteristics of the intervention’: CRISP was valued but time consuming; 2. ‘inner setting’: the practice was open to changing systems; 3. ‘outer setting’: CRISP helped facilitate screening; 4. ‘individual characteristics’: the practice staff were adaptable and able to facilitate adoption of new clinical processes; and 5. ‘processes’: fidelity checking and education was important.
Conclusions
These results describe a novel method for exploring implementation strategies for a colorectal cancer risk prediction tool in the context of a parallel RCT testing clinical efficacy. The study identified successful and unsuccessful implementation strategies using an adaptive methodology over time. This method emphasised the importance of co-design input to make an intervention like CRISP sustainable for use in other practices and with other risk tools.
Trial registration
N/A
Figure 1
Figure 2
This is a list of supplementary files associated with this preprint. Click to download.
Loading...