Objectives

Australian guidelines recommend all 50 to 70-year-olds without existing contraindications consider taking low-dose aspirin (100 mg – 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.

Methods

Semi-structured 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.

Results

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, the precise wording of the recommendation, previous changes to guidelines about aspirin, and conflicting findings from trials in older populations were barriers to implementation.

Conclusion

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.

Qualitative transcript data were managed using NVivo 12. The interviews for each type of participant; FCC staff, GPs, gastroenterologists and pharmacists were initially analysed separately. Complete coding of each interview was conducted by the author who interviewed the participant where everything that was spoken by the participants was organised into specific topics. At the first level of coding, codes were produced inductively for each of the participant professional groups upon completion. For enhanced interpretive rigour, several interviews in each participant group were co-coded by another researcher and progressively checked in regular researcher meetings. The coding for several interviews per participant type was checked by a second researcher.

After first-level coding, codes were grouped into themes. Thematic analysis was employed at this level where themes emerged from the first-level coding through discussions between the researchers. About 20 themes per professional group type were defined. Themes from each professional group type were discussed between the researchers and brought together if they could be. Themes were then mapped onto the domain and constructs from the CFIR: characteristics of intervention, outer setting, inner setting, characteristics of individuals, and process.

This is a qualitative dataset.