Centre for Cancer Research, University of Melbourne, Melbourne, Australia.
Department of General Practice, University of Melbourne, Melbourne, Australia.
Implement Sci. 2022 May 12;17(1):31. doi: 10.1186/s13012-022-01205-8.
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.
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 operations 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.
Between December 2016 and September 2019, 1 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.
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.
我们开发了一种结直肠癌风险预测工具（“CRISP”），为结直肠癌筛查提供基于个体风险的建议。CRISP 使用已知的环境、行为和家族风险因素设计，旨在为 50 至 74 岁的普通科患者提供个性化的筛查建议。在对 CRISP 工具进行随机对照试验的同时，我们还开发并评估了一种基于证据的实施策略。
采用定性方法探讨 CRISP 在普通科的实施情况。我们选择澳大利亚维多利亚州的一家普通科诊所作为“实验室”，测试将 CRISP 嵌入常规临床实践的方法。普通科医生、护士和运营经理与研究人员共同设计实施方法，重点关注可持续的现有实践流程。研究人员定期采访员工，评估所采用策略的成功程度，并根据定性访谈的反馈意见在整个研究期间调整实施方法。实施研究的综合框架（CFIR）为访谈指南和干预策略的制定提供了依据。编码是归纳性的，主题是通过作者之间的共识发展起来的。新兴主题被映射到 CFIR 领域，并制定了一个保真度检查表，以确保 CRISP 按预期使用。
2016 年 12 月至 2019 年 9 月期间，进行了 1 次面对面和 1 次视频会议（Zoom）访谈。所有访谈均进行了逐字记录和编码。主题被映射到以下 CFIR 领域：（1）“干预措施的特征”：CRISP 受到重视，但耗时；（2）“内在环境”：该实践对改变系统持开放态度；（3）“外在环境”：CRISP 有助于促进筛查；（4）“个体特征”：实践工作人员具有适应性，能够促进新的临床流程的采用；（5）“过程”：保真检查和教育很重要。
这些结果描述了一种新颖的方法，用于在平行 RCT 测试临床疗效的背景下探索结直肠癌风险预测工具的实施策略。该研究通过随时间推移的自适应方法确定了成功和不成功的实施策略。该方法强调了共同设计投入的重要性，以使 CRISP 等干预措施在其他实践中以及与其他风险工具一起使用时具有可持续性。
