Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2019

ImpleMenting the Aspirin Guidelines Into Clinical care (I-MAGIC project) (#244)

Shakira R Milton 1 2 3 , Jennifer McIntosh 1 2 , Pavrithan Alphonse 1 2 , Thivagar Yogaparan 1 2 , Sibel Saya 1 2 , Napin Karnchanachari 1 2 , Phyllis Lau 2 , Finlay Macrae 4 5 , Jon Emery 1 2 6
  1. Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australlia
  2. Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
  3. University of Melbourne, Melbourne, VICTORIA, Australia
  4. Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
  5. Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Melbourne, Victoria , Australia
  6. The Primary Care Unit, University of Cambridge, Cambridge, United Kingdom

In 2017, Cancer Council Australia updated their guidelines for the prevention of colorectal cancer (CRC) to recommend that all people aged 50-70 who are at average risk of CRC actively consider taking aspirin to reduce their risk.

Interviews were conducted with a range of health professionals whom the new guidelines may apply, including gastroenterologists, geneticists, genetic counsellors, pharmacists and general practitioners. Interviews explored their current practice, knowledge and opinions toward recommending aspirin to people at average risk of CRC and potential barriers and facilitators to implementing the guidelines. An expected frequency tree showing the potential harms and benefits of aspirin was also developed to facilitate discussion of the risks and benefits of aspirin with patients. Interviews were coded using thematic analysis and themes were mapped onto the Consolidated Framework for Implementation Research.

Results from interviews with 10 general practitioners (GP), 17 staff from familial cancer clinics (FCC) (3 oncologists, 4 geneticists and 10 genetic counsellors) and 17 gastroenterologists will be presented. Interviews with pharmacists and general practitioners are continuing. Analysis is ongoing.

Emerging themes suggest that GPs are generally unaware of the guidelines and are concerned with them because of the changing recommendation for aspirin with cardiovascular disease. There is general awareness about recommendations for high-risk patients (e.g. Lynch Syndrome) to take aspirin but some surprise, particularly from gastroenterologists, that recommendations extend to those at average risk. FCC staff and gastroenterologists are more likely to consult patients at moderate or high risk of CRC and suggest that GPs may be better placed to discuss the use of aspirin as a preventive medication with those at average risk.

These interviews, plus those with other health professionals, will aid the development of an implementation strategy for these updated guidelines, identifying optimal ways to ensure patients can make an informed decision regarding aspirin.