Clinicians’ opinions on recommending aspirin to prevent colorectal cancer to Australians aged 50–70 years: a qualitative study

Australian guidelines recommend all 50–70 year olds without contraindications consider taking low-dose aspirin for at least 2.5 years to reduce their risk of developing colorectal cancer. In this qualitative study, ECRN member Shakira Milton and team explored clinicians’ practices, knowledge, opinions, and barriers and facilitators to the implementation of these new guidelines through semi-structured interviews. Sixty-four clinicians were included and were made up of geneticists, oncologists, genetic counsellors, gastroenterologists, pharmacists and general practitioners (GPs). Interview coding was inductive and themes were developed through consensus between the authors. Aspirin was viewed as a safe and cheap option for cancer prevention, with GPs considered by all clinicians as the most important health professionals for implementation of the guidelines. Cancer Council Australia, as a trusted organisation, was an important facilitator to guideline adoption. Uncertainty about aspirin dosage, perceived strength of the evidence, precise wording of the recommendation, previous changes to guidelines about aspirin and conflicting findings from trials in older populations were the most common barriers to implementation. Widespread adoption of these new guidelines could be an important strategy to reduce the incidence of bowel cancer, however a more active implementation strategy focused on primary care and the wider community would be necessary.

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