title: Clinician-Reported Barriers to Implementing Breast Cancer Chemoprevention in the UK: A Qualitative Investigation.
abstract: The use of tamoxifen and raloxifene as preventive therapy for women at increased risk of breast cancer was approved by the National Institute for Health and Care Excellence (NICE) in 2013. We undertook a qualitative investigation to investigate the factors affecting the implementation of preventive therapy within the UK.
  
  
  
  We recruited general practitioners (GPs) (n = 10) and clinicians working in family history or clinical genetics settings (FHCG clinicians) (n = 15) to participate in semi-structured interviews. Data were coded thematically within the Consolidated Framework for Implementation Research.
  
  
  
  FHCG clinicians focussed on the perceived lack of benefit of preventive therapy and difficulties interpreting the NICE guidelines. FHCG clinicians felt poorly informed about preventive therapy, and this discouraged patient discussions on the topic. GPs were unfamiliar with the concept of preventive therapy, and were not aware that they may be asked to prescribe it for high-risk women. GPs were reluctant to initiate therapy because it is not licensed, but were willing to continue a prescription if it had been started in secondary or tertiary care.
  
  
  
  Barriers to implementing preventive therapy within routine clinical practice are common and could be addressed by engaging all stakeholders during the development of policy documents.
authors.affiliation: Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
authors.forename: Samuel G
authors.initials: SG
authors.lastname: Smith
authors.forename: Lucy
authors.initials: L
authors.lastname: Side
authors.forename: Susanne F
authors.initials: SF
authors.lastname: Meisel
authors.forename: Rob
authors.initials: R
authors.lastname: Horne
authors.forename: Jack
authors.initials: J
authors.lastname: Cuzick
authors.forename: Jane
authors.initials: J
authors.lastname: Wardle
mesh_terms: D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000517:prevention & control*; D018890:Chemoprevention / Q000523:psychology; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family / Q000523:psychology*; D036301:Qualitative Research; D020849:Raloxifene Hydrochloride / Q000627:therapeutic use; D013629:Tamoxifen / Q000627:therapeutic use; D006113:United Kingdom
chemical_list: D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen; D020849:Raloxifene Hydrochloride