Table 2 Illustrative quotes for subthemes of embracing the shift to mainstream genetic testing.

Inner setting—implementation climate—relative priority

Individuals’ shared perception of the importance of the implementation within the organization¹⁵

Clinical utility

“I guess it's reassuring, I suppose, to know that yes we have tested and having that result on hand and so then advising about chemo choices. I've also been able to go back and test historical patients that might not have met eligibility when we first met and now can be tested, so some retrospective test as well to sort of know, yes okay we've done that and I now know that a PARP inhibitor is not in your treatment paradigm” (P08, OHP)

“I think in the gynae space they see it as important. But probably in a different way to us obviously because the PARP inhibitors and treatment option for those women, they see it important for that woman's care, whereas we see it as important for the rest of the family” (P16, GHP)

Implementation process—executing

Carrying out or accomplishing the implementation according to plan¹⁵

Current mainstream process and future adaptation

“I think one of our key concerns is making sure that results get to where they need to go and are acted upon appropriately, making sure that these people are found to have variants, that they then subsequently get referred to the familial cancer center to for a proper assessment and discussion” (P7, OHP)

“Although there was a pathway that was part of the training module, there was a lot of kinks to work out, particularly in terms of results delivery and also in terms of who felt responsible for ordering the testing” (P3, GHP)

Outer setting—patients’ needs

The extent to which patient needs, as well as barriers and facilitators to meet those needs, are accurately known and prioritized by the organization¹⁵

Importance of maintaining a patient centered process

“I think case by case really and just feeling out how the patient's traveling with information load, but we would have it on the initial consultation, we'd have it on the to-do list at the first consultation and sometimes they're keen to discuss that at first consultation or it might be subsequent consultations” (P12, OHP)

“They knew the patients well and had that regular contact with them, so they could just work out the right timing to raise it and also knowing where their treatment was at, knowing when it’s going to benefit the treatment decisions” (P01, GHP)