Table 2.

Implementation factors for mainstreaming genetic testing for colorectal and endometrial cancer.

CFIR (Domain—construct)	Genetics health professional (GHP) responses	Oncology health professional (OHP) responses
Intervention characteristics—relative advantage Stakeholders’ perception of the advantage of implementing the intervention vs. an alternative solution [28].	Relative advantage
	“It seems inevitable and likely will occur in other cancers too”	“This is the obvious next step for the identified patients with dMMR tumours having access to appropriate assessment for hereditary cancer risk vs. acquired change”
Intervention characteristics—complexity	Complexity
Perceived difficulty of implementation, reflected by duration, scope, radicalness, disruptiveness, centrality and intricacy and number of steps required to implement [28].	“I think mainstreaming panel testing for CRC and EC has many more complexities associated with it compared to mainstreaming for breast or ovarian cancer. Also associated treatment implications are less obvious than with breast and ovarian cancer”	“Whilst integrated testing can occur at diagnosis - results are not available before surgery and may not be made available prior to commencement of adjuvant chemotherapy. A better approach may be to automate familial cancer clinic/genetic counsellor consultations (rather that knee-jerk panel testing) to coincide with oncology appointments to ensure patients have access to informed discussion and can adequately consent to panel testing.”
Intervention characteristics—cost Costs of the intervention and costs associated with implementing the intervention including investment, supply and opportunity costs [28].	Cost
	“Pathology flags and recommendations/notifications on histopathology reports and Medicare funding for MMR panels”	"Routine reimbursement and automatic test once the diagnosis made."
Inner setting—networks and communication The nature and quality of webs of social networks and the nature and quality of formal and informal communications within an organisation [28].	Communication networks and collaboration
	“Mainstreaming genetic testing programmes like those used effectively for many years in breast and ovarian cancer should be referred to as they have successfully allowed for a co-ordinated approach between oncology staff and genetics”	“There are several sites with a lot of experience in mainstreaming for ovarian and breast cancer. It works very well with a close collaboration with a genetic department who supported and monitored the implementation for ovarian cancer. I would recommend the same with CRC and EC”
	Genetics point of contact
	“Having genetics staff physically co-located with cancer services, to build relationships and increase communication between the specialities”	“Adequate support to clinician in initial phase and also ongoing support from genetics. I think a clinician can learn the needed process—such as we did for BRCA mainstreaming—quite readily. The issue with panel testing is that I suspect it will change over time. There needs to be a mechanism where clinicians can get support from genetics readily and also be able to refer to genetics at any stage for review of case”
Individuals involved—other personal attributes A broad construct to include other personal traits, such as tolerance of ambiguity, intellectual ability, motivation, values, competence, capacity and learning style [28].	Role delineation
	“Genetic testing by oncology team and referral to genetics if patient is positive”	“I think the counselling is best brought in at surgical level as it will capture all colorectal cancer patients. Oncologists only see the proportion of colorectal cancer patients that have high-risk stage II/stage III /stage IV cancer. We need testing done on all of the early-stage I and II cancers as well.” “The family of patients are NOT under the responsibility of clinicians beyond general pre- consent information. Genetics need to take on all family for counselling and testing and the responsibility for ensuring this occurs this should not fall on the clinician”