Readiness and leadership for the implementation of polygenic risk scores: Genetic healthcare providers' perspectives in the hereditary cancer context

Abstract

Genetic healthcare providers and organizations must be made ready for potential future clinical implementation of polygenic risk scores (PRS) for hereditary breast and ovarian (HBOC) cancer risk assessment. Understanding the multi-level factors that contribute to readiness for change will assist leaders with strategic planning and selection of facilitative implementation strategies, ultimately reducing resource wastage and increasing the likelihood of implementation success. Evidence is missing on the current state of readiness in the Australian cancer genomics sector. The aim of this study was to explore genetic healthcare providers' perspectives on organizational readiness and leadership. Participants were recruited through professional networks to complete an online, quantitative survey encompassing multiple validated evidence-based tools. Analyses included descriptive and inferential statistics. Participants (N = 40) were majority female (N = 31, 77.5%) and in clinical roles (N = 31, 77.5%). A high level of personal capability and organizational readiness was found, with current workplace behaviors and culture being enablers for implementation. Barriers to readiness were knowledge of implementation and evaluative processes for PRS and insufficient resourcing. Leaders were confident in their roles and supportive and perseverant behaviors. Participants in non-leadership roles regarded leadership at an average level. Overall, leadership proactivity toward implementation of PRS for HBOC risk assessment was low. If implementation is to be successful, investment in further developing organizational climates conducive to change is required, focusing on interventions to bolster entrepreneurial leadership behaviors and increase implementation competency and resourcing. Further research into readiness and leadership in clinical cancer genetics is needed.

Keywords: hereditary breast and ovarian cancer risk assessment; implementation; leadership; organizational readiness; polygenic risk scores.

FIGURE 1

Participants' (N = 38) beliefs about the value and implementation of PRS for HBOC risk assessment in clinical cancer genetics practice, as interrogated using the EBP Beliefs scale. Participants scored their level of disagreement or agreement with each belief statement using a Likert scale from 1 to 5, with 1 = strongly disagree through to 5 = strongly agree. Average score and standard deviation for each belief statement is shown. A higher total percentage indicates a higher level of agreement with each belief (shaded blue where agreement is ≥80%), and more positive beliefs toward implementation of PRS for HBOC risk assessment. A lower level of agreement with each belief is shaded orange. The accompanying bar graph reflects the level of agreement, with orange = strongly disagree or disagree, and blue = strongly agree or agree. Gray represents a neutral response. (^ = reversed‐scored).

FIGURE 2

Participants' (N = 33) perspectives on organizational readiness for the implementation of PRS for HBOC risk assessment, as interrogated with the ORIC. Participants scored their level of disagreement or agreement with each statement about organizational readiness using a Likert scale from 1 to 5, with 1 = strongly disagree through to 5 = strongly agree. Percentage of participants strongly disagreeing or disagreeing (orange color), neither disagreeing or agreeing (gray color) and strongly agreeing or agreeing (blue color) is shown. A higher level of agreement indicates higher positive organization culture and readiness for the implementation of PRS for HBOC risk assessment.