Implementation Mapping for Managing Patients at High Risk for Hereditary Cancer

Abstract

IntroductionCurrently, no standard workflow exists for managing patients with pathogenic variants (PVs) that put them at higher risk for hereditary cancers. As a result, follow-up care for individuals with PVs is logistically challenging and results in poor guideline adherence. This research addressed this challenge by creating clinical management strategies for individuals identified as high risk for hereditary cancers. MethodsAn implementation mapping approach was used to develop and evaluate the establishment of a Hereditary Cancer Clinic (HCC) at the Medical University of South Carolina (MUSC) throughout 2022 and 2023. This approach consisted of five steps: conduct a needs assessment, identify objectives, select implementation strategies, produce implementation protocols, and develop an evaluation plan. The needs assessment consisted of qualitative interviews with patients (n=11), specialists (n=9), and members of the implementation team (n=4). Interviews were coded using the Consolidated Framework for Implementation Research (CFIR) to identify barriers and facilitators to establishment of the HCC. Objectives were identified, then the team selected implementation strategies, and produced implementation protocols to address concerns identified during the needs assessment. A second round of patient interviews was conducted to assess patient education materials. ResultsThe research team developed a long-term evaluation plan to guide future assessment of implementation, service, and clinical/patient outcomes. ConclusionsThis approach provides the opportunity for real-time enhancements and impact, with strategies for care specialists, patients, and implementation teams. Findings support ongoing efforts to improve patient management and outcomes, while providing an opportunity for long-term evaluation of implementation strategies and guidelines for patients at high risk for hereditary cancers.