Implementing Cancer Genomics in State Health Agencies: Mapping Activities to an Implementation Science Outcome Framework

Abstract

Objective: To show how state health agencies can plan and evaluate activities to strengthen the evidence base for public health genomics, we mapped state cancer genomics activities to the Doyle et al. [Genet Med. 2018;20(9):995–1003] implementation science outcome framework. Methods: We identified state health agency activities addressing hereditary breast and ovarian cancer and Lynch syndrome by reviewing project narratives from Centers for Disease Control and Prevention Cancer Genomics Program funding recipients, leading discussions with state health agencies, and conducting an environmental scan. Results: State health agencies’ cancer genomics activities included developing or adding to state surveillance systems, developing educational materials, bidirectional reporting, promoting health plan policy change, training providers, and promoting recommendations and standards. To address health disparities, programs have tracked group differences, developed culturally appropriate educational materials, and promoted access to services for underserved populations. Conclusion: State health agencies can use the Doyle et al. [Genet Med. 2018;20(9):995–1003] performance objectives and outcome measures to evaluate proposed and ongoing activities. By demonstrating whether activities result in improved outcomes, state health agencies can build the evidence for the implementation of cancer genomics activities.

Structured approaches to implementation of clinical genomics: A scoping review

“…[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Studies/reports were categorized according to the level of clinical health care addressed: the health care system (ie, strategic), an organization (ie, operational), or a team (ie, operational). Most commonly, studies targeted both organization and team levels (n = 11), [16][17][18][19][30][31][32][33][34][35][36] followed by the health care systems and organizations (n = 8). 15,[21][22][23][24][25]27,29 Gray literature studies most commonly addressed health care systems and organizations (n = 7), [21][22][23][24][25]27,29 whereas peer-reviewed studies most commonly addressed the organization and team levels (n = 11) (Supplemental File 5).…”

“…15,[21][22][23][24][25]27,29 Gray literature studies most commonly addressed health care systems and organizations (n = 7), [21][22][23][24][25]27,29 whereas peer-reviewed studies most commonly addressed the organization and team levels (n = 11) (Supplemental File 5). [16][17][18][19]30,[32][33][34][35][36][37] Most studies/reports identified were driven by government bodies (n = 13), [21][22][23][25][26][27][28][29]31,[38][39][40][41] with 10 of these as government reports rather than research studies. [21][22][23][25][26][27][28][29]40,41 Another 13 were conducted by independent academics.…”

“…A total of 7 studies were conducted by research groups (ie, a network of researchers collaborating on a project from different institutions) 14,16,20,24,33,36,47 and 1 was a commercial endeavor. 37 Examples of specific research groups involved in this field included the Genomics and Public Health Action Collaborative, 33,34 Implementing GeNomics In practice Network, 16,18,20,42 and the International Consortium for Personalised Medicine. 14…”

“…In total, we identified 30 newly created/proposed structured approaches to the implementation of clinical genomics presented in 30 studies/reports 4,14-22,24-33,35-37,39-44,47 and 4 pre-existing approaches in 4 studies/reports. 23,34,38,45 Most approaches were identified in peer-reviewed articles (n = 23), [14][15][16][17][18][19][20][30][31][32][33][34][35][36][37][38][39][42][43][44][45][46][47] whereas 11 were identified in gray literature. [21][22][23][24][25][26][27][28][29]40,41 The United States contributed the majority of structured approaches with 17 publications identified.…”

“…[21][22][23][24][25][26][27][28][29]40,41 The United States contributed the majority of structured approaches with 17 publications identified. 15,16,[18][19][20]30,[32][33][34][35][36][37][38]42,43,46,47 Most studies/reports that included structured approaches were published within the last 5 years (n = 23). [14][15][16][17][18][19][20][21]23,26,30,31,[33][34][35][36][37][38][39][40][41][42][43] In total, 22 of the approaches were intended for use in both research and practic...…”