Development, Evaluation, and User Testing of a Decision-Making Toolkit to Promote Organizations to Implement Universal Tumor Screening for Lynch Syndrome

Introduction:The Implementing Universal Lynch SyndromeScreening (IMPULSS) study explained institutional variationin universal tumor screening (UTS) with the goal of identi-fying ways to aid organizational decision-makers in im-plementing and optimizing Lynch syndrome UTS programs.Methods:After applying the Consolidated Framework forImplementation Research (CFIR 1.0) to analyze interviewswith 66 stakeholders across 9 healthcare systems to developa toolkit for implementation, we adapted the InternationalPatient Decision Aid Standards (IPDAS) to assess toolkitpotential to aid decision-making consistent with organiza-tional values. We then conducted user testing with twoexperienced and four non-experienced implementers of UTSto improve the content and functionality of the toolkit andassess its acceptability and appropriateness.Results:Toolkitcomponents were organized to addressfindings related toCFIR 1.0 constructs of evidence strength and quality, relativeadvantage, cost, engaging, planning, executing, and re-flecting and evaluating. A home page was added to directusers to different sections based on whether they are de-ciding to implement UTS, planning for implementation,improving an existing UTS program, or considering a dif-ferent approach to identify patients with Lynch syndrome.Upon initial evaluation, 31 of 64 IPDAS criteria were met bythe original toolkit. All users rated the toolkit as acceptableand appropriate for assisting organizational decision-making and identified multiple areas for improvement.Numerous iterative changes were made to the toolkit, re-sulting in meeting 17 of the previously unmet IPDAS criteria.Conclusion:We demonstrate the rigorous development of atoolkit guided by the CFIR and show how user testing helpedimprove the toolkit to ensure it is acceptable, appropriate,and meets most IPDAS criteria relevant to organizationalvalues-based decision-making.(c) 2024 The Author(s).Published by S. Karger AG, Basel