Exploring clinicians' attitudes about using aspirin for risk reduction in people with Lynch Syndrome with no personal diagnosis of colorectal cancer.
Recent research has shown that aspirin reduces the risk of cancers associated with Lynch Syndrome. However, uncertainty exists around the optimal dosage, treatment duration and whether the benefits of aspirin as a risk-reducing medication (RRM) outweigh adverse medication related side-effects. Little is known about clinicians' attitudes, current practice, and perceived barriers to recommending aspirin as a RRM. To explore the attitudes of clinicians who discuss risk management options with patients with Lynch Syndrome towards using aspirin as a RRM. Clinicians were invited through professional organisations to complete an online survey. Topics included their clinical experience with Lynch Syndrome, views and practice of recommending aspirin as a RRM, and knowledge about clinical risk management guidelines for Lynch Syndrome. Comparison of attitudes was made between three professional groups. 181 respondents were included in the analysis: 59 genetics professionals (genetic counsellors and clinical geneticists, medical oncologists with specialist training in familial cancer), 49 gastroenterologists and 73 colorectal surgeons. Most clinicians (76 %) considered aspirin to be an effective RRM and most (72 %) were confident about discussing it. In all professional categories, those who were confident about discussing aspirin with patients perceived it to be an effective RRM (OR = 2.8 [95 % CI = 1.8-4.2], p < 0.001). Eighty percent (47/59) of genetics professionals reported having discussed the use of aspirin with Lynch Syndrome patients compared to 69 % of gastroenterologists and 68 % of colorectal surgeons. Those who considered aspirin as an effective RRM or who felt confident in their knowledge of the aspirin literature were more likely (OR = 10 [95 % CI = 1.5-65], p = 0.010, OR = 6 [95 % CI = 2.2-16], p < 0.001, respectively) to discuss it with their patients than other professionals in the study. Similarly health professionals who felt confident in their knowledge of literature of aspirin/confident in discussing with the patients were more likely (OR = 6 [95 % CI = 2.2-16], p < 0.001) to discuss with their patients. Health professionals who saw more than ten patients with Lynch Syndrome per year were more likely to be confident in their knowledge of the aspirin literature and discussing it with patients (OR = 4.1 [95 % CI = 1.6-10.2], p = 0.003). Explicit recommendations to take aspirin, was reported by 65/83 (78 %) of health professionals. Eighty-seven percent of health professionals reported a need for patient educational materials about aspirin. Continuing training is needed to increase clinicians' confidence in their knowledge of the literature on the use of aspirin as a RRM. Patient education materials may be helpful in improving consistency in patient care and facilitate communication between clinicians and people living with Lynch Syndrome.
Sydney Medical School - Northern, Kolling Institute Level 7, Royal North Shore Hospital, University of Sydney, Sydney, NSW, 2065, Australia.|Department of Psychosocial Oncology, National Cancer Centre, Singapore, 169610, Singapore.
Yanni
Y
Chen
Psychosocial Research Group, Lowy Cancer Research Centre C25, Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, 2052, Australia.|Department of Obstetrics and Gynaecology, Level 7, Royal Women's Hospital, University of Melbourne, 20 Flemington Road, Parkville, VIC, 3052, Australia.
Michelle
M
Peate
Psychosocial Research Group, Lowy Cancer Research Centre C25, Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, 2052, Australia. rajneesh.kaur@unsw.edu.au.
Rajneesh
0000-0002-4406-4327
R
Kaur
Psychosocial Research Group, Lowy Cancer Research Centre C25, Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, 2052, Australia.
Bettina
B
Meiser
School of Social Sciences, University of New South Wales, Sydney, NSW, 2052, Australia.
Tim
T
Wong
Westmead Institute for Cancer Research, Westmead Millennium Institute, Sydney, NSW, Australia.|Familial Cancer Service, Westmead Hospital, Sydney, Australia.
Judy
J
Kirk
University of Queensland, Brisbane, QLD, 4067, Australia.
Robyn L
RL
Ward
Medical Oncology, Concord Cancer Centre, Sydney, NSW, 2138, Australia.
Annabel
A
Goodwin
Colorectal Medicine and Genetics and University Dept of Medicine, Royal Melbourne Hospital, Melbourne, VIC, 3050, Australia.
Finlay
F
Macrae
School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, 3000, Australia.
Janet
J
Hiller
Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, 3002, Australia.
Alison H
AH
Trainer
Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, 3002, Australia.|Sir Peter MacCallum Deparment of Oncology, University of Melbourne, Melbourne, VIC, 3052, Australia.
Gillian
G
Mitchell
D001241:Aspirin / Q000627:therapeutic use*; D001315:Australia; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000150:complications*; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians
D001241:Aspirin
Aspirin; Clinicians’ attitudes; Colorectal cancer; Colorectal surgeons; Gastroenterologist; Genetics professionals; Lynch Syndrome; Personal diagnosis; Risk-reduction medication
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