RT Journal Article
SR Electronic
T1 GPs’ willingness to prescribe aspirin for cancer preventive therapy in Lynch syndrome: a factorial randomised trial investigating factors influencing decisions
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP BJGP.2021.0610
DO 10.3399/BJGP.2021.0610
A1 Kelly E Lloyd
A1 Louise H Hall
A1 Lucy Ziegler
A1 Robbie Foy
A1 Gillian M Borthwick
A1 Mairead MacKenzie
A1 David G Taylor
A1 Samuel G Smith
A1 ,
YR 2023
UL http://bjgp.org/content/early/2023/03/08/BJGP.2021.0610.abstract
AB Background The National Institute for Health and Care Excellence (NICE) 2020 guidelines recommends aspirin for colorectal cancer prevention for people with Lynch syndrome. Strategies to change practice should be informed by understanding the factors influencing prescribing.Aim To investigate the optimal type and level of information to communicate with GPs to increase willingness to prescribe aspirin.Design and setting GPs in England and Wales (n = 672) were recruited to participate in an online survey with a 23 factorial design. GPs were randomised to one of eight vignettes describing a hypothetical patient with Lynch syndrome recommended to take aspirin by a clinical geneticist.Method Across the vignettes, the presence or absence of three types of information was manipulated: 1) existence of NICE guidance; 2) results from the CAPP2 trial; 3) information comparing risks/benefits of aspirin. The main effects and all interactions on the primary (willingness to prescribe) and secondary outcomes (comfort discussing aspirin) were estimated.Results There were no statistically significant main effects or interactions of the three information components on willingness to prescribe aspirin or comfort discussing harms and benefits. In total, 80.4% (540/672) of GPs were willing to prescribe, with 19.7% (132/672) unwilling. GPs with prior awareness of aspirin for preventive therapy were more comfortable discussing the medication than those unaware (P = 0.031).Conclusion It is unlikely that providing information on clinical guidance, trial results, and information comparing benefits and harms will increase aspirin prescribing for Lynch syndrome in primary care. Alternative multilevel strategies to support informed prescribing may be warranted.