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Understanding implementation success: protocol for an in-depth, mixed-methods process evaluation of a cluster randomised controlled trial testing methods to improve detection of Lynch syndrome in Australian hospitals
  1. April Morrow1,2,
  2. Katherine M Tucker3,4,
  3. Tim J Shaw5,
  4. Bonny Parkinson6,
  5. Charles Abraham7,
  6. Luke Wolfenden8,
  7. Natalie Taylor1,2
  1. 1Cancer Council New South Wales, Woolloomooloo, New South Wales, Australia
  2. 2The University of Sydney, Sydney, New South Wales, Australia
  3. 3Hereditary Cancer Clinic, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
  4. 4UNSW Prince of Wales Clinical School, Randwick, New South Wales, Australia
  5. 5Research in Implementation Science and eHealth (RISe), Faculty of Health Sciences, University of Sydney, Camperdown, New South Wales, Australia
  6. 6The Macquarie University Centre for the Health Economy, Macquarie University, Macquarie, New South Wales, Australia
  7. 7Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
  8. 8School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
  1. Correspondence to April Morrow; april.morrow{at}


Introduction In multisite intervention trials, implementation success often varies widely across settings. Process evaluations are crucial to interpreting trial outcomes and understanding contextual factors and causal chains necessary for successful implementation. Lynch syndrome is a hereditary cancer predisposition conferring an increased risk of colorectal, endometrial and other cancer types. Despite systematic screening protocols to identify Lynch syndrome, the condition remains largely underdiagnosed. The Hide and Seek Project (‘HaSP’) is a cluster randomised controlled trial determining the effectiveness of two approaches to improving Lynch syndrome detection at eight Australian hospital networks. To enhance widespread implementation of optimal Lynch syndrome identification, there is a need to understand not only what works, but also why, in what contexts, and at what costs. Here we describe an in-depth investigation of factors influencing successful implementation of procedures evaluated in the HaSP trial.

Methods and analysis A mixed-methods, theory-driven process evaluation will be undertaken in parallel to the HaSP trial. Data will include: interviews of Implementation Leads and Lynch syndrome stakeholders, pre–post implementation questionnaires, audio analysis of meetings and focus groups, observation of multidisciplinary team meetings, fidelity checklists and project log analysis. Results will be triangulated and coded, drawing on the Theoretical Domains Framework, Consolidated Framework for Implementation Research and Proctor’s implementation outcomes.

Ethics and dissemination Use of a theory-based process evaluation will enhance interpretation and generalisability of HaSP trial findings, and contribute to the implementation research field by furthering understanding of the conditions necessary for implementation success. Ethical approval has been granted and results will be disseminated via publications in peer-reviewed journals and conference presentations. At trial completion, key findings will be fed back to sites to enable refinement of intervention strategies, both in the context of Lynch syndrome and for the possible generalisability of intervention components in other genetic and broader clinical specialties.

HaSP trial registration number Australian New Zealand Clinical Trials Registry (Identifier: ACTRN12618001072202). Registered 27 June 2018.

  • process evaluation
  • lynch syndrome
  • implementation
  • theoretical domains framework
  • genetic testing

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  • Contributors AM was responsible for study design and protocol development. NT was responsible for the original concept of the process evaluation and supervised AM in study design and protocol development. KMT, TJS, BP, CA and LW all provided input into study design and will provide data analysis input as the process evaluation progresses. AM drafted the initial manuscript, and NT, KMT, TJS, BP, CA and LW all read, revised and approved the final manuscript.

  • Funding AM is a recipient of an Australian Government Research Training Programme Scholarship and a Translational Cancer Research Network Clinical PhD Scholarship Top-up award, supported by the Cancer Institute NSW. Funding support has also been provided by Cancer Council NSW.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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