Box 3.

Clusters arising from the barriers to and facilitators of implementation

Cluster	Barriers	Facilitators
Time taken to complete the tool	Amount of time required to complete a CanRisk assessment, communicate the outcomes, and discuss management options.	The tool is easy to navigate by GPs and nurses (PNs and NPs). A patient-facing version of the CanRisk tool could facilitate risk factor and family history data capture.
Compatibility and integration with existing primary care IT systems and ways of working	Lack of integration of the CanRisk tool into the EHR. Individual resistance to electronic risk assessment tools.	Professionals are already used to similar risk assessment tools.
Opportunities for use within primary care	The competing priorities within primary care. Causing anxiety to patients.	The potential clinical impact of the CanRisk tool in general and its potential value in appointments (for example, pill checks, HRT, and smear tests) where discussions around breast cancer risk happen. The potential benefit of reassuring women in the population risk category.
Need for training and capacity building within healthcare teams	Professionals’ lack of confidence regarding their knowledge about breast cancer. Professionals’ lack of experience using electronic pedigree family history drawing tools. Time-consuming and complicated family history section in the current version of the CanRisk tool. Professionals’ lack of knowledge and experience prescribing risk-reducing medication.	General practices having protected training time to learn about new interventions such as the CanRisk tool. Relationships of trust and support among professionals within a given setting.

EHR = electronic health record. HRT = hormone replacement therapy. NP = nurse practitioner. PN = practice nurse.