Key result
General practitioners and patients with Lynch syndrome face significant barriers to implementing aspirin for cancer prevention, including uncertainty about dosing, concerns over side effects, and unclear healthcare pathways.
Why the study?
Deciding whether to initiate daily aspirin to reduce colorectal cancer risk in Lynch syndrome can be a complex decision for patients and providers because benefits and harms must be weighed.
What are the barriers and facilitators to using aspirin for preventive therapy in people with Lynch syndrome?
What are the barriers and facilitators to using aspirin for preventive therapy in people with Lynch syndrome?
Coordinated strategies are needed to address the needs of GPs and patients with Lynch syndrome to ensure consistent implementation of national guidance on aspirin for preventive therapy.
GP barriers may delay aspirin chemoprevention in Lynch syndrome; leaves open targeted education and pathway interventions.
BACKGROUND: The National Institute for Health and Care Excellence (NG151) recommends considering daily aspirin for people with Lynch syndrome to reduce colorectal cancer risk. However, deciding whether to initiate aspirin could be a complex decision for patients and their healthcare providers, as both the potential benefits and harms need to be considered. METHODS: We conducted semi-structured interviews to explore the barriers and facilitators to using aspirin for preventive therapy. We recruited 15 people with Lynch syndrome, and 23 healthcare providers across multiple professions in primary, and specialist care (e.g. clinical genetics) in the United Kingdom. Interview schedules were informed by the Theoretical Domains Framework. RESULTS: There were three themes: 1) Considering potential harms and benefits; 2) Healthcare pathway; 3) Patients' level of interest in aspirin. All healthcare providers, across primary and specialist care, viewed general practitioners (GPs) as being responsible for prescribing and overseeing the use of aspirin. However, GPs were unfamiliar with aspirin for preventive therapy, and concerned about prescribing at higher doses (300-600 mg). To support decision-making, GPs wanted clarification from specialist clinicians on the evidence and dose to prescribe. Not all participants with Lynch syndrome received information on aspirin from their healthcare provider, and several were unsure who to discuss aspirin with. GPs were more inclined to prescribe aspirin for patients with expressed preferences for the medication, however several patients were uncertain and wanted further guidance. CONCLUSIONS: Coordinated and multilevel strategies are needed, addressing the needs of both GPs and people with Lynch syndrome, to ensure consistent implementation of national guidance on aspirin for preventive therapy.
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Lloyd et al. (2022) studied Lynch syndrome (n=38). Aspirin was evaluated on Barriers and facilitators to using aspirin for preventive therapy. General practitioners and patients with Lynch syndrome face significant barriers to implementing aspirin for cancer prevention, including uncertainty about dosing, concerns over side effects, and unclear healthcare pathways.
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