Exploring clinicians’ attitudes about using aspirin for risk reduction in people with Lynch Syndrome with no personal diagnosis of colorectal cancer

Chen, Yanni, Peate, Michelle, Kaur, Rajneesh, Meiser, Bettina, Wong, Tim, Kirk, Judy, Ward, Robyn L., Goodwin, Annabel, Macrae, Finlay, Hiller, Janet, Trainer, Alison H. and Mitchell, Gillian (2017) Exploring clinicians’ attitudes about using aspirin for risk reduction in people with Lynch Syndrome with no personal diagnosis of colorectal cancer. Familial Cancer, 16 1: 99-109. doi:10.1007/s10689-016-9933-1


Author Chen, Yanni
Peate, Michelle
Kaur, Rajneesh
Meiser, Bettina
Wong, Tim
Kirk, Judy
Ward, Robyn L.
Goodwin, Annabel
Macrae, Finlay
Hiller, Janet
Trainer, Alison H.
Mitchell, Gillian
Title Exploring clinicians’ attitudes about using aspirin for risk reduction in people with Lynch Syndrome with no personal diagnosis of colorectal cancer
Journal name Familial Cancer   Check publisher's open access policy
ISSN 1573-7292
1389-9600
Publication date 2017-01-01
Sub-type Article (original research)
DOI 10.1007/s10689-016-9933-1
Open Access Status Not yet assessed
Volume 16
Issue 1
Start page 99
End page 109
Total pages 11
Place of publication Dordrecht, Netherlands
Publisher Springer
Language eng
Abstract 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.
Formatted abstract
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.
Keyword Aspirin
Clinicians’ attitudes
Colorectal cancer
Colorectal surgeons
Gastroenterologist
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ
Additional Notes Published online 27 September 2016

Document type: Journal Article
Sub-type: Article (original research)
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Created: Tue, 04 Oct 2016, 20:18:54 EST by Amelie Casgrain on behalf of School of Medicine