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Milton S, Macrae F, McIntosh JG, Saya S, Alphonse P, Yogaparan T, Karnchanachari N, Novy K, Nguyen P, Lau P, Emery J. Designing a decision aid for cancer prevention: a qualitative study. Fam Pract 2024; 41:349-359. [PMID: 37058423 PMCID: PMC11167968 DOI: 10.1093/fampra/cmad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
OBJECTIVES Australian guidelines recommend people aged 50-70 years old consider taking low-dose aspirin to reduce their risk of colorectal cancer. The aim was to design sex-specific decision aids (DAs) with clinician and consumer input, including expected frequency trees (EFTs) to communicate the risks and benefits of taking aspirin. METHODS Semi-structured interviews were conducted with clinicians. Focus groups were conducted with consumers. The interview schedules covered ease of comprehension, design, potential effects on decision-making, and approaches to implementation of the DAs. Thematic analysis was employed; independent coding by 2 researchers was inductive. Themes were developed through consensus between authors. RESULTS Sixty-four clinicians were interviewed over 6 months in 2019. Twelve consumers aged 50-70 years participated in two focus groups in February and March 2020. The clinicians agreed that the EFTs would be helpful to facilitate a discussion with patients but suggested including an additional estimate of the effects of aspirin on all-cause mortality. The consumers felt favourable about the DAs and suggested changes to the design and wording to ease comprehension. CONCLUSION DAs were designed to communicate the risks and benefits of low-dose aspirin for disease prevention. The DAs are currently being trialled in general practice to determine their impact on informed decision-making and aspirin uptake.
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Affiliation(s)
- Shakira Milton
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Finlay Macrae
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Melbourne, Australia
| | - Jennifer G McIntosh
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Sibel Saya
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Pavithran Alphonse
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Thivagar Yogaparan
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Napin Karnchanachari
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Kitty Novy
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Peter Nguyen
- Health and Government Sector, Quantium, Melbourne, Australia
| | - Phyllis Lau
- Department of General Practice, University of Melbourne, Melbourne, Australia
- School of Medicine, University of Western Sydney, Sydney, Australia
| | - Jon Emery
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
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Kaur R, McDonald C, Meiser B, Macrae F, Smith SK, Kang YJ, Caruana M, Mitchell G. The Risk-Reducing Effect of Aspirin in Lynch Syndrome Carriers: Development and Evaluation of an Educational Leaflet. ADVANCED GENETICS (HOBOKEN, N.J.) 2022; 3:2100046. [PMID: 36618023 PMCID: PMC9744515 DOI: 10.1002/ggn2.202100046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Indexed: 01/11/2023]
Abstract
Carriers of germline mutations in genes associated with Lynch syndrome are at increased risk for colorectal, endometrial, ovarian, and other cancers. There is evidence that daily consumption of aspirin may reduce cancer risk in these individuals. There is a need for educational resources to inform carriers of the risk-reducing effects of aspirin or to support decision-making. An educational leaflet describing the risks and benefits of using aspirin as risk-reducing medicine in carriers of Lynch-syndrome-related mutations is developed and pilot tested in 2017. Carriers are ascertained through a familial cancer clinic and surveyed using a mailed, self-administered questionnaire. The leaflet is highly rated for its content, clarity, length, relevance, and visual appeal by more than 70% of the participants. Most participants (91%) report "a lot" or "quite a bit" of improvement in perceived understanding in knowledge about who might benefit from taking aspirin, its benefits, how long to take it, the reduction in bowel cancer risk, and the optimal dosage. A few (14%) participants seek more information on the dosage of aspirin. This leaflet will be useful as an aid to facilitate discussion between patients and their health care professionals about the use of aspirin as a risk-reducing medication.
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Affiliation(s)
- Rajneesh Kaur
- Medical Education OfficeUNSW SydneyNew South WalesAustralia,Medical Education OfficeThe University of SydneyEdward Ford BuildingSydneyNew South Wales2006Australia
| | - Cassandra McDonald
- The Kinghorn Cancer CentreSt Vincent HospitalVictoria StreetDarlinghurstNew South Wales2010Australia
| | - Bettina Meiser
- Psychosocial Research GroupUNSW SydneyHigh StreetSydneyNew South Wales2052Australia
| | - Finlay Macrae
- Department of Colorectal Medicine and Geneticsand Department of MedicineThe Royal Melbourne HospitalUniversity of MelbourneParkvilleVictoria3010Australia
| | - Sian K Smith
- Psychosocial Research GroupUNSW SydneyHigh StreetSydneyNew South Wales2052Australia
| | - Yoon Jung Kang
- Daffodil CentreUniversity of SydneySydneyNew South Wales2006Australia
| | - Michael Caruana
- Daffodil CentreUniversity of SydneySydneyNew South Wales2006Australia
| | - Gillian Mitchell
- Familial Cancer CentrePeter MacCallum Cancer CentreParkvilleVictoria3010Australia,The Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoria3052Australia
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Lloyd KE, Hall LH, King N, Thorneloe RJ, Rodriguez-Lopez R, Ziegler L, Taylor DG, MacKenzie M, Smith SG. Aspirin use for cancer prevention: A systematic review of public, patient and healthcare provider attitudes and adherence behaviours. Prev Med 2022; 154:106872. [PMID: 34762964 PMCID: PMC8803547 DOI: 10.1016/j.ypmed.2021.106872] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 09/08/2021] [Accepted: 11/04/2021] [Indexed: 12/21/2022]
Abstract
We undertook a systematic review to synthesise the data on attitudes and behaviour towards the use of aspirin for cancer prevention, and healthcare providers' attitudes towards implementing aspirin in practice. Searches were carried out across 12 databases (e.g. MEDLINE, EMBASE). We used the Mixed Methods Appraisal Tool to evaluate study quality, and conducted a narrative synthesis of the data. The review was pre-registered (PROSPERO: CRD42018093453). Thirty-eight studies were identified. Uptake and adherence data were all from trials. Trials recruited healthy participants, those at higher risk of cancer, and those with cancer. Four studies reported moderate to high (40.9-77.7%) uptake to an aspirin trial among people who were eligible. Most trials (18/22) reported high day-to-day adherence (≥80%). Three trials observed no association between gender and adherence. One trial found no association between adherence and colorectal cancer risk. Three studies reported moderate to high (43.6-76.0%) hypothetical willingness to use aspirin. Two studies found that a high proportion of healthcare providers (72.0-76.0%) perceived aspirin to be a suitable cancer prevention option. No qualitative studies were identified. The likelihood that eligible users of aspirin would participate in a trial evaluating the use of aspirin for preventive therapy was moderate to high. Among participants in a trial, day-to-day adherence was high. Further research is needed to identify uptake and adherence rates in routine care, the factors affecting aspirin use, and the barriers to implementing aspirin into clinical care.
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Affiliation(s)
- Kelly E Lloyd
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - Louise H Hall
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Natalie King
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Rachael J Thorneloe
- Centre for Behavioural Science & Applied Psychology, Sheffield Hallam University, Sheffield, UK
| | | | - Lucy Ziegler
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - David G Taylor
- School of Pharmacy, University College London, London, UK
| | | | - Samuel G Smith
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Ricardo Hamilton AE, Lin AA, Young CJ. The Benefits of Colorectal Surgery Surveys in Australia and New Zealand. Ann Coloproctol 2020; 36:102-111. [PMID: 32429010 PMCID: PMC7299568 DOI: 10.3393/ac.2019.09.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/17/2019] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Pertaining to the Colorectal Surgery Society of Australia and New Zealand (CSSANZ) Executive and Research Support Committee, this study aimed to assess the usefulness and outcomes of surveys sent out by the society to its members. METHODS From 2009 to 2017, CSSANZ members received 38 surveys, most of which were distributed from within the society, and a few of which originated from other affiliated groups. Surveys were categorised by type, topics, times required for completion, delivery method, response rates, and advancement to publication. RESULTS Of 38 surveys, 20 (53%) were published and 18 remain unpublished. Four surveys were distributed annually on average, with 2.2 published annually on average, with a mean impact factor of 2.41 ± 1.55. Mean time to publication was 31 ± 17 months. Surveys contributed to 13 publications (34%). The most common survey topics were rectal cancer decisionmaking, in 6 publications (16%), preoperative assessment of colorectal patients, in 5 publications (13%), and anal physiology: continence and defaecation, in 4 publications (11%). Publication of surveys was not related to the number of surveys distributed per year, the number of questions per survey, or the time required by respondents to complete the surveys. CONCLUSION Most of the CSSANZ-distributed surveys resulted in publications, and one third of the surveys contributed to higher degrees obtained by investigators. These surveys aid research into areas that are otherwise difficult to assess, often indicating areas for future research.
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Affiliation(s)
- Auerilius Erastus Ricardo Hamilton
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,The University of Sydney, Central Clinical School, Sydney, New South Wales, Australia
| | - Amelia Alice Lin
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,The University of Sydney, Central Clinical School, Sydney, New South Wales, Australia
| | - Christopher John Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,The University of Sydney, Central Clinical School, Sydney, New South Wales, Australia
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Smith SG, Foy R, McGowan J, Kobayashi LC, Burn J, Brown K, Side L, Cuzick J. General practitioner attitudes towards prescribing aspirin to carriers of Lynch Syndrome: findings from a national survey. Fam Cancer 2017; 16:509-516. [PMID: 28434157 PMCID: PMC5603645 DOI: 10.1007/s10689-017-9986-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A dose non-inferiority study comparing 100 mg, 300 mg and 600 mg of aspirin for cancer prevention among Lynch Syndrome carriers is underway (Colorectal Adenoma/Carcinoma Prevention Programme trial 3, CaPP3). To guide implementation of the findings, we investigated general practitioner (GP) attitudes towards aspirin prescribing for Lynch Syndrome carriers. We surveyed 1007 UK GPs (9.6% response rate). Using a within-subjects design, GPs read a statement on harms and benefits of aspirin and indicated their willingness to prescribe aspirin at three doses (100 mg, 300 mg, 600 mg). Approximately two-thirds (70.8%) of GPs had heard of Lynch Syndrome or its associated names, and among those 46.7% were aware of the cancer preventive effects of aspirin among carriers. Two-thirds (68.1%) of GPs reported feeling comfortable discussing harms and benefits of aspirin with a Lynch Syndrome patient. Willingness to prescribe was 91.3% at 100 mg, and declined to 81.8% at 300 mg and 62.3% at 600 mg (p < 0.001). In multivariable analyses, willingness to prescribe (600 mg) was higher among GPs ≥50 years (OR 1.46, 95% CI 1.03-2.07), more experienced GPs (OR 1.50, 95% CI 1.10-2.04), GPs who were aware of the cancer preventive effects of aspirin (OR 1.58, 95% CI 1.20-2.09), and those who reported seeing a Lynch Syndrome patient in practice (OR 1.44, 95% CI 1.01-2.05, p = 0.045). GPs report limited awareness of Lynch Syndrome and the preventive effects of aspirin among carriers. To ensure the optimal dose identified in the CaPP3 trial is readily available to patients, prescribing guidance and strategies to educate GPs should be developed.
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Affiliation(s)
- Samuel G Smith
- Leeds Institute of Health Sciences, University of Leeds, Floor 10, Worsley Building, Leeds, LS2 9JT, UK.
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
| | - Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Floor 10, Worsley Building, Leeds, LS2 9JT, UK
| | - Jennifer McGowan
- Institute of Epidemiology and Healthcare, University College London, London, UK
| | - Lindsay C Kobayashi
- Harvard T. H. Chan School of Public Health, Center for Population and Development Studies, Harvard University, Cambridge, MA, USA
| | - John Burn
- Institute of Genetic Medicine, Newcastle University, Newcastle, UK
| | - Karen Brown
- Department of Cancer Studies, University of Leicester, Leicester, UK
| | - Lucy Side
- Institute for Women's Health, University College London, London, UK
| | - Jack Cuzick
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
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