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Latt PM, Soe NN, Fairley C, Xu X, King A, Rahman R, Ong JJ, Phillips TR, Zhang L. Assessing the effectiveness of HIV/STI risk communication displays among Melbourne Sexual Health Centre attendees: a cross-sectional, observational and vignette-based study. Sex Transm Infect 2024; 100:158-165. [PMID: 38395609 PMCID: PMC11041604 DOI: 10.1136/sextrans-2023-055978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/13/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Increasing rates of sexually transmitted infections (STIs) over the past decade underscore the need for early testing and treatment. Communicating HIV/STI risk effectively can promote individuals' intention to test, which is critical for the prevention and control of HIV/STIs. We aimed to determine which visual displays of risk would be the most likely to increase testing or use of prevention strategies. METHODS A vignette-based cross-sectional survey was conducted with 662 clients (a median age of 30 years (IQR: 25-36), 418 male, 203 female, 41 other genders) at a sexual health clinic in Melbourne, Australia, between February and June 2023. Participants viewed five distinct hypothetical formats, presented in a randomised order, designed to display the same level of high risk for HIV/STIs: icon array, colour-coded risk metre, colour-coded risk bar, detailed text report and guideline recommendation. They reported their perceived risk, concern and intent to test for each risk display. Associations between the format of the risk display and the intention to test for HIV/STI were analysed using logistic regression. RESULTS About 378 (57%) of participants expressed that the risk metre was the easiest to understand. The risk metre (adjusted OR (AOR)=2.44, 95% CI=1.49 to 4.01) and risk bar (AOR=2.08, CI=1.33 to 3.27) showed the greatest likelihood of testing compared with the detailed text format. The icon array was less impactful (AOR=0.73, CI=0.57 to 0.94). The risk metre also elicited the most concern but was the most preferred and understood. High-risk perception and concern levels were strongly associated with their intention to have an HIV/STI test. CONCLUSIONS Displaying risk differently affects an individual's perceived risk of an HIV/STI and influences their intention to test.
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Affiliation(s)
- Phyu Mon Latt
- Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Nyi Nyi Soe
- Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Christopher Fairley
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Xianglong Xu
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Alicia King
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Rashidur Rahman
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Jason J Ong
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Tiffany R Phillips
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Lei Zhang
- Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Clinical Medical Research Center, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu Province 210008, China
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Usher-Smith JA, Hindmarch S, French DP, Tischkowitz M, Moorthie S, Walter FM, Dennison RA, Stutzin Donoso F, Archer S, Taylor L, Emery J, Morris S, Easton DF, Antoniou AC. Proactive breast cancer risk assessment in primary care: a review based on the principles of screening. Br J Cancer 2023; 128:1636-1646. [PMID: 36737659 PMCID: PMC9897164 DOI: 10.1038/s41416-023-02145-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 02/05/2023] Open
Abstract
In the UK, the National Institute for Health and Care Excellence (NICE) recommends that women at moderate or high risk of breast cancer be offered risk-reducing medication and enhanced breast screening/surveillance. In June 2022, NICE withdrew a statement recommending assessment of risk in primary care only when women present with concerns. This shift to the proactive assessment of risk substantially changes the role of primary care, in effect paving the way for a primary care-based screening programme to identify those at moderate or high risk of breast cancer. In this article, we review the literature surrounding proactive breast cancer risk assessment within primary care against the consolidated framework for screening. We find that risk assessment for women under 50 years currently satisfies many of the standard principles for screening. Most notably, there are large numbers of women at moderate or high risk currently unidentified, risk models exist that can identify those women with reasonable accuracy, and management options offer the opportunity to reduce breast cancer incidence and mortality in that group. However, there remain a number of uncertainties and research gaps, particularly around the programme/system requirements, that need to be addressed before these benefits can be realised.
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Affiliation(s)
- Juliet A. Usher-Smith
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sarah Hindmarch
- grid.5379.80000000121662407Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - David P. French
- grid.5379.80000000121662407Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Marc Tischkowitz
- grid.5335.00000000121885934Department of Medical Genetics, National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Sowmiya Moorthie
- grid.5335.00000000121885934PHG Foundation, University of Cambridge, Cambridge, UK
| | - Fiona M. Walter
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK ,grid.4868.20000 0001 2171 1133Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Rebecca A. Dennison
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Francisca Stutzin Donoso
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephanie Archer
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK ,grid.5335.00000000121885934Department of Psychology, University of Cambridge, Cambridge, UK
| | - Lily Taylor
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jon Emery
- grid.1008.90000 0001 2179 088XCentre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, VIC Australia
| | - Stephen Morris
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Douglas F. Easton
- grid.5335.00000000121885934Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Antonis C. Antoniou
- grid.5335.00000000121885934Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Gorman LS, Ruane H, Woof VG, Southworth J, Ulph F, Evans DG, French DP. The co-development of personalised 10-year breast cancer risk communications: a 'think-aloud' study. BMC Cancer 2022; 22:1264. [PMID: 36471302 PMCID: PMC9721070 DOI: 10.1186/s12885-022-10347-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/21/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Risk stratified breast cancer screening is being considered as a means of improving the balance of benefits and harms of mammography. Stratified screening requires the communication of risk estimates. We aimed to co-develop personalised 10-year breast cancer risk communications for women attending routine mammography. METHODS We conducted think-aloud interviews on prototype breast cancer risk letters and accompanying information leaflets with women receiving breast screening through the UK National Breast Screening Programme. Risk information was redesigned following feedback from 55 women in three iterations. A deductive thematic analysis of participants' speech is presented. RESULTS Overall, participants appreciated receiving their breast cancer risk. Their comments focused on positive framing and presentation of the risk estimate, a desire for detail on the contribution of individual risk factors to overall risk and effective risk management strategies, and clearly signposted support pathways. CONCLUSION Provision of breast cancer risk information should strive to be personal, understandable and meaningful. Risk information should be continually refined to reflect developments in risk management. Receipt of risk via letter is welcomed but concerns remain around the acceptability of informing women at higher risk in this way, highlighting a need for co-development of risk dissemination and support pathways.
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Affiliation(s)
- Louise S. Gorman
- grid.498924.a0000 0004 0430 9101The Nightingale Centre and Prevent Breast Cancer Centre Research Unit, Manchester University NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT UK
| | - Helen Ruane
- grid.498924.a0000 0004 0430 9101The Nightingale Centre and Prevent Breast Cancer Centre Research Unit, Manchester University NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT UK
| | - Victoria G. Woof
- grid.5379.80000000121662407Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, The University of Manchester, MAHSC, Oxford Road, Manchester, M13 9PL UK
| | - Jake Southworth
- grid.498924.a0000 0004 0430 9101The Nightingale Centre and Prevent Breast Cancer Centre Research Unit, Manchester University NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT UK
| | - Fiona Ulph
- grid.5379.80000000121662407Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, The University of Manchester, MAHSC, Oxford Road, Manchester, M13 9PL UK
| | - D. Gareth Evans
- grid.498924.a0000 0004 0430 9101The Nightingale Centre and Prevent Breast Cancer Centre Research Unit, Manchester University NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT UK ,grid.498924.a0000 0004 0430 9101Department of Genomic Medicine, Division of Evolution and Genomic Science, MAHSC, University of Manchester, Manchester University NHS Foundation Trust, Oxford Road, M13 9WL, Manchester, UK ,grid.498924.a0000 0004 0430 9101NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, England UK
| | - David P. French
- grid.5379.80000000121662407Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, The University of Manchester, MAHSC, Oxford Road, Manchester, M13 9PL UK ,grid.498924.a0000 0004 0430 9101NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, England UK
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Vegunta S, Kuhle CL, Vencill JA, Lucas PH, Mussallem DM. Sexual Health after a Breast Cancer Diagnosis: Addressing a Forgotten Aspect of Survivorship. J Clin Med 2022; 11:6723. [PMID: 36431200 PMCID: PMC9698007 DOI: 10.3390/jcm11226723] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/12/2022] [Accepted: 11/02/2022] [Indexed: 11/16/2022] Open
Abstract
Breast cancer is the most common cancer in women. The life expectancy after a breast cancer diagnosis is improving steadily, leaving many more persons with the long-term consequences of treatment. Sexual problems are a common concern for breast cancer survivors yet remain overlooked in both the clinical setting and the research literature. Factors that contribute to sexual health concerns in breast cancer survivors are biopsychosocial, as are the barriers to addressing and treating these health concerns. Sexual health needs and treatment may vary by anatomy and gender. Multidisciplinary management may comprise lifestyle modifications, medications, sexual health aids such as vibrators, counseling, and referrals to pelvic health physical therapy and specialty care. In this article, we review the contributing factors, screening, and management of sexual difficulties in cisgender female breast cancer survivors. More information is needed to better address the sexual health of breast cancer survivors whose sexual/gender identity differs from that of cisgender women.
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Affiliation(s)
- Suneela Vegunta
- Division of Women’s Health Internal Medicine, Mayo Clinic, 13400 Shea Blvd, Scottsdale, AZ 85259, USA
| | - Carol L. Kuhle
- Menopause and Women’s Sexaul Health Clinic, Mayo Clinic, Rochester, MN 55905, USA
| | - Jennifer A. Vencill
- Menopause and Women’s Sexaul Health Clinic, Mayo Clinic, Rochester, MN 55905, USA
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | - Pauline H. Lucas
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Dawn M. Mussallem
- Jacoby Center for Breast Health, Mayo Clinic, Jacksonville, FL 32224, USA
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Vegunta S, Bhatt AA, Choudhery SA, Pruthi S, Kaur AS. Identifying women with increased risk of breast cancer and implementing risk-reducing strategies and supplemental imaging. Breast Cancer 2021; 29:19-29. [PMID: 34665436 DOI: 10.1007/s12282-021-01298-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
Breast cancer (BC) is the second most common cancer in women, affecting 1 in 8 women in the United States (12.5%) in their lifetime. However, some women have a higher lifetime risk of BC because of genetic and lifestyle factors, mammographic breast density, and reproductive and hormonal factors. Because BC risk is variable, screening and prevention strategies should be individualized after considering patient-specific risk factors. Thus, health care professionals need to be able to assess risk profiles, identify high-risk women, and individualize screening and prevention strategies through a shared decision-making process. In this article, we review the risk factors for BC, risk-assessment models that identify high-risk patients, and preventive medications and lifestyle modifications that may decrease risk. We also discuss the benefits and limitations of various supplemental screening methods.
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Affiliation(s)
- Suneela Vegunta
- Division of Women's Health Internal Medicine, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA.
| | - Asha A Bhatt
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Sandhya Pruthi
- Division of General Internal Medicine, Breast Cancer Clinic, Mayo Clinic, Rochester, MN, USA
| | - Aparna S Kaur
- Division of General Internal Medicine, Breast Cancer Clinic, Mayo Clinic, Rochester, MN, USA
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Milton S, McIntosh J, Boyd L, Karnchanachari N, Macrae F, Emery JD. Commentary: Pivoting during a pandemic: developing a new recruitment model for a randomised controlled trial in response to COVID-19. Trials 2021; 22:605. [PMID: 34496930 PMCID: PMC8424147 DOI: 10.1186/s13063-021-05567-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/24/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Many non-COVID-19 trials were disrupted in 2020 and either struggled to recruit participants or stopped recruiting altogether. In December 2019, just before the pandemic, we were awarded a grant to conduct a randomised controlled trial, the Should I Take Aspirin? (SITA) trial, in Victoria, the Australian state most heavily affected by COVID-19 during 2020. MAIN BODY We originally modelled the SITA trial recruitment method on previous trials where participants were approached and recruited in general practice waiting rooms. COVID-19 changed the way general practices worked, with a significant increase in telehealth consultations and restrictions on in person waiting room attendance. This prompted us to adapt our recruitment methods to this new environment to reduce potential risk to participants and staff, whilst minimising any recruitment bias. We designed a novel teletrial model, which involved calling participants prior to their general practitioner appointments to check their eligibility. We delivered the trial both virtually and face-to-face with similar overall recruitment rates to our previous studies. CONCLUSION We developed an effective teletrial model which allowed us to complete recruitment at a high rate. The teletrial model is now being used in our other primary care trials as we continue to face the impacts of the COVID-19 pandemic.
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Affiliation(s)
- Shakira Milton
- Centre for Cancer Research, University of Melbourne, Level 10, 305 Grattan Street, Melbourne, VIC, 3000, Australia.
- Department of General Practice, University of Melbourne, Melbourne, Australia.
| | - Jennifer McIntosh
- Department of General Practice, University of Melbourne, Melbourne, Australia
- HumaniSE Lab, Department of Software Systems and Cybersecurity, Monash University, Melbourne, Victoria, Australia
| | - Lucy Boyd
- Centre for Cancer Research, University of Melbourne, Level 10, 305 Grattan Street, Melbourne, VIC, 3000, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Napin Karnchanachari
- Centre for Cancer Research, University of Melbourne, Level 10, 305 Grattan Street, Melbourne, VIC, 3000, 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
| | - Jon David Emery
- Centre for Cancer Research, University of Melbourne, Level 10, 305 Grattan Street, Melbourne, VIC, 3000, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
- The Primary Care Unit, University of Cambridge, Cambridge, UK
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Macdonald C, Saunders CM, Keogh LA, Hunter M, Mazza D, McLachlan SA, Jones SC, Nesci S, Friedlander ML, Hopper JL, Emery JD, Hickey M, Milne RL, Phillips KA. Breast Cancer Chemoprevention: Use and Views of Australian Women and Their Clinicians. Cancer Prev Res (Phila) 2020; 14:131-144. [PMID: 33115784 DOI: 10.1158/1940-6207.capr-20-0369] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/27/2020] [Accepted: 10/15/2020] [Indexed: 11/16/2022]
Abstract
Guidelines endorse the use of chemoprevention for breast cancer risk reduction. This study examined the barriers and facilitators to chemoprevention use for Australian women at increased risk of breast cancer, and their clinicians. Surveys, based on the Theoretical Domains Framework, were mailed to 1,113 women at ≥16% lifetime risk of breast cancer who were enrolled in the Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer cohort study (kConFab), and their 524 treating clinicians. Seven hundred twenty-five women (65%) and 221 (42%) clinicians responded. Only 10 (1.4%) kConFab women had ever taken chemoprevention. Three hundred seventy-eight (52%) kConFab women, two (3%) breast surgeons, and 51 (35%) family physicians were not aware of chemoprevention. For women, the strongest barriers to chemoprevention were side effects (31%) and inadequate information (23%), which operate in the Theoretical Domains Framework domains of "beliefs about consequences" and "knowledge," respectively. Strongest facilitators related to tamoxifen's long-term efficacy (35%, "knowledge," "beliefs about consequences," and "goals" domains), staying healthy for family (13%, "social role" and "goals" domains), and abnormal breast biopsy (13%, "environmental context" domain). The strongest barrier for family physicians was insufficient knowledge (45%, "knowledge" domain) and for breast surgeons was medication side effects (40%, "beliefs about consequences" domain). The strongest facilitators for both clinician groups related to clear guidelines, strong family history, and better tools to select patients ("environmental context and resources" domain). Clinician knowledge and resources, and beliefs about the side-effect consequences of chemoprevention, are key domains that could be targeted to potentially enhance uptake. PREVENTION RELEVANCE: Despite its efficacy in reducing breast cancer incidence, chemoprevention is underutilised. This survey study of Australian women and their clinicians used behavioural change theory to identify modifiable barriers to chemoprevention uptake, and to suggest interventions such as policy change, educational resources and public campaigns, that may increase awareness and use.See related Spotlight by Vogel, p. 1.
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Affiliation(s)
- Courtney Macdonald
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
| | | | - Louise A Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Morgan Hunter
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Danielle Mazza
- Department of General Practice, Monash University, Melbourne, Australia
| | - Sue-Anne McLachlan
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Australia.,Department of Medical Oncology, St Vincent's Hospital, Fitzroy, Melbourne, Australia
| | - Sandra C Jones
- ACU Engagement, Australian Catholic University, Melbourne, Australia
| | - Stephanie Nesci
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Michael L Friedlander
- Prince of Wales Clinical School University of New South Wales, Sydney, Australia.,Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Jon D Emery
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Australia.,School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women's Hospital, Melbourne, Australia
| | - Roger L Milne
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Australia
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Benefits and harms of aspirin to reduce colorectal cancer risk: a cross-sectional study of methods to communicate risk in primary care. Br J Gen Pract 2019; 69:e843-e849. [PMID: 31740461 DOI: 10.3399/bjgp19x706613] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/21/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND New Australian guidelines recommend that GPs actively consider prescribing low-dose aspirin to patients aged 50-70 years to reduce their risk of developing colorectal cancer (CRC). Patients and GPs need to understand the relative benefits and harms to support informed decision making. AIM To develop and examine different methods to communicate the benefits and harms of taking aspirin for CRC prevention. DESIGN AND SETTING A cross-sectional, vignette study with patients aged 50-70 years consecutively recruited from general practices in Melbourne, Australia, between July and August 2018. METHOD Summary estimates from meta-analyses of the effects of aspirin on the incidence of CRC, cardiovascular disease, gastrointestinal bleeding, and incidence rates in the Australian population to estimate outcomes in a hypothetical population of 10 000 people aged 50-70 years. These estimates were presented using four different risk communication formats. Participants were shown these different formats and asked if they would take aspirin to prevent CRC. RESULTS A total of 313 participants were recruited (95.1% recruitment rate), of whom 304 completed the study. Most participants (71.7-75.3%) reported they would take aspirin irrespective of risk format presented. Bar charts (odds ratio [OR] 1.20, 95% confidence intervals [CI] = 1.01 to 1.44) and expected frequency trees (OR 1.18, 95% CI = 0.99 to 1.41) were more strongly associated with the intentions to take aspirin compared with icon arrays. Bar charts were most preferred for presenting risk information. CONCLUSION A large proportion of participants in this study intended to take aspirin to reduce their CRC risk regardless of risk communication format. Bar charts and expected frequency trees were the preferred methods to present the benefits and harms of taking aspirin to prevent CRC.
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