Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia.
BMJ Open. 2021 Feb 5;11(2):e042261. doi: 10.1136/bmjopen-2020-042261.
Australian guidelines recommend all adults aged 50-70 years old without existing contraindications consider taking low-dose aspirin (100-300 mg per day) for at least 2.5 years to reduce their risk of developing colorectal cancer. We aimed to explore clinicians' practices, knowledge, opinions, and barriers and facilitators to the implementation of these new guidelines.
Semistructured interviews were conducted with clinicians to whom the new guidelines may be applicable (Familial Cancer Clinic staff (geneticists, oncologists and genetic counsellors), gastroenterologists, pharmacists and general practitioners (GPs)). The Consolidated Framework for Implementation Research (CFIR) underpinned the development of the interview guide. Coding was inductive and themes were developed through consensus between the authors. Emerging themes were mapped onto the CFIR domains: characteristics of the intervention, outer setting, inner setting, individual characteristics and process.
Sixty-four interviews were completed between March and October 2019. Aspirin was viewed as a safe and cheap option for cancer prevention. GPs were 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 and 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 barriers to implementation.
Widespread adoption of these new guidelines could be an important strategy to reduce the incidence of bowel cancer, but this will require more active implementation strategies focused on primary care and the wider community.
Australian New Zealand Clinical Trials Registry (ACTRN12620001003965).
澳大利亚指南建议所有无禁忌症的 50-70 岁成年人考虑服用低剂量阿司匹林（每天 100-300 毫克）至少 2.5 年，以降低患结直肠癌的风险。我们旨在探讨临床医生的实践、知识、意见以及实施这些新指南的障碍和促进因素。
对可能适用新指南的临床医生（家族癌症诊所工作人员（遗传学家、肿瘤学家和遗传咨询师）、胃肠病学家、药剂师和全科医生（GP））进行半结构化访谈。实施研究整合框架（CFIR）为访谈指南的制定提供了基础。编码是归纳性的，主题是通过作者之间的共识开发的。新兴主题被映射到 CFIR 领域：干预措施的特征、外部环境、内部环境、个体特征和过程。
2019 年 3 月至 10 月期间完成了 64 次访谈。阿司匹林被所有临床医生视为预防癌症的安全且廉价的选择。全科医生被所有临床医生认为是实施指南的最重要的卫生专业人员。澳大利亚癌症协会作为一个值得信赖的组织，是指南采用的重要促进因素。对阿司匹林剂量和证据强度的不确定性、建议的确切措辞、以前关于阿司匹林的指南变化以及在老年人群中试验的相互矛盾的结果，是实施的障碍。
广泛采用这些新指南可能是降低肠癌发病率的重要策略，但这需要更积极的实施策略，重点关注初级保健和更广泛的社区。
澳大利亚新西兰临床试验注册中心（ACTRN12620001003965）。
