Support from genetic counselors was regarded as facilitative for considering hereditary basis of CRC diagnosis, but there was variability in awareness of and access to this expertise. Clinicians identified advantage of molecular tumor analysis prior to genetic testing, but tumor testing was infrequently used due to perceived low disease burden. Specialists were more likely than primary care clinicians to obtain family history to investigate hereditary colorectal cancer (CRC), but with limited detail clinicians suggested templates to facilitate retrieval and documentation of family history according to guidelines. Data collection and analysis were informed by two conceptual frameworks, the Greenhalgh Diffusion of Innovation and Andersen Behavioral Model, to allow for concurrent examination of both access and innovation factors. We conducted semi-structured interviews with 58 clinicians to understand use of the following genomic services for colorectal care: family health history documentation, molecular and genetic testing, and genetic counseling. examined facilitators and barriers to adoption of genomic services for colorectal care, one of the first genomic medicine applications, within the Veterans Health Administration to shed light on areas for practice change. 9 Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, MT 638, 1720 2nd Avenue South, Birmingham, AL 35294, USA. 8 Health Services Research & Development Service, 700 S. 7 Department of Veterans Affairs, Cooperative Studies Program Epidemiology Center, 411 West Chapel Hill Street, Suite 600, Durham, NC 27701, USA. 6 VAMC, 4150 Clement Street, San Francisco, CA 94121, USA. 5 Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, 411 West Chapel Hill Street, Suite 500, Durham, NC 27701, USA. 4 Center for Health Services Research in Primary Care, Health Services Research & Development Service, 411 West Chapel Hill Street, Suite 600, Durham, NC 27701, USA. 3 Center for Health Services Research in Primary Care, Health Services Research & Development Service, 411 West Chapel Hill Street, Suite 600, Durham, NC 27701, USA. 2 Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, 411 West Chapel Hill Street, Suite 500, Durham, NC 27701, USA. 1 Center for Health Services Research in Primary Care, Health Services Research & Development Service, 411 West Chapel Hill Street, Suite 600, Durham, NC 27701, USA. With two rooms that can be rented for private events, please contact us to host your next party, rehearsal dinner or shower. We are open for Lunch Wednesday- Friday from 11:30 - 4:00, serve Dinner Monday - Thursday 5:00 - 10:00, Friday and Saturday 5:00 - 10:30 and are open for Sunday Brunch from 10:30 - 2:00, and Sunday Dinner from 5:00 to 9:30 411 West, an Italian restaurant in Chapel Hill, NC, specializing in seasonal fresh pastas, wood-fired pizzas, fresh seafood, steaks, and specials inspired by the flavors of Italy and the Mediterranean.Ĭatering, Groups, Reserve, Takeout, Waiter, WalkinsĤ11 West has been open on Franklin Street in Chapel Hill since 1990, serving fresh, local ingredients from local farms in Italian and Mediterranean dishes.
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