Table 1.

Semi-structured interview guide for key informants to evaluate awareness of and experience with genomic services for colorectal cancer care in the Veterans Health Administration.

Background	What is your current VHA position (manager, staff physician, service chief)? For how long have you been in your current position? For how long have you been at the VHA?
Availability	Please tell me what genomic services are available at your VHA facility to identify hereditary colorectal cancer. (ASK ABOUT: MSI/IHC analysis, genetic sequencing, and genetic counseling.)
Requesting Services	How are requests made? (Probes: Who makes the referral? Who approves the referral? How are the results documented? What are challenges? What is helpful?) IF PARTICIPANT MAKES REFERRALS FOR GENOMIC SERVICES, ASK: What factors help you decide which patients to refer [Specify what type of test: MSI, IHC, genetic sequencing]? (Probes: Age of diagnosis, presence of family history, known mutation in family.) Related to colorectal cancer, are there any tests you order reflexively, without request from gastroenterology or oncology?
Family History Documentation	How is family history documented in the medical record at your VHA facility? (Probes: When is it documented (e.g., initial visit to primary care, upon referral to specialist, at time of diagnosis)? Who documents it? Where do they document it? What information do they document? When family history is documented, how many generations are typically included?) What resources or systems are available for documenting family history (Probe: charts, forms, templates)? What reasons do you think clinicians would give for difficulty documenting family history? (Probe: for whether lack of standardization or specific place for family history documentation is a barrier, or whether the current system within the facility works despite lack of standardization.)
Making Referral Decisions	When a Veteran younger than age 50 is diagnosed with colorectal cancer, what services are considered standard at your facility as the next step in that patient’s care? If no mention of Bethesda guidelines or Amsterdam criteria, ask: Are you familiar with the Bethesda Guidelines and the Amsterdam Criteria? (NOTE: See criteria within this document; can review with respondent as needed)
Informing Patient	How are patients informed of results? (Probes: Who is responsible for discussing results with the patient? Which visit (primary care, oncology, gastroenterology)? What resources are available at your facility to support the clinician in interpreting results and informing the patient? What steps are taken to inform family members of the results?)
Informing Care	IF NON-VHA GENOMIC SERVICE, ASK: How are results reported back to the VHA facility? (Probes: How are the results documented? What time is required to receive the results? How are clinicians informed of the results?) How are the results of a genomic test (NOTE: specify if molecular test or genomic sequencing) used to inform a plan for preventive or prophylactic intervention for CRC?
	Do you have any comments regarding services related to hereditary colon cancer that you would like to add? That completes the interview. Would you be able to suggest anyone else at your facility who might be knowledgeable about the evaluation of hereditary colorectal cancer? Thank you very much for your time.