A fifth of GPs may be reluctant to prescribe aspirin for patients with Lynch syndrome because of the potential harms.
NICE guidelines recommend aspirin to be considered for patients with Lynch syndrome to reduce their heightened risk of colorectal cancer.
But analysis from a survey of 672 GPs in England and Wales found almost 20% were probably not willing or not at all willing to offer aspirin in patients with Lynch syndrome.
The study by researchers at the University of Leeds, also found that providing clinical guidance recommending its use, summarising trial evidence, or giving information on aspirin’s benefits and harms did not alter their stance on prescribing the drug.
It may be that alternative strategies are needed to support GPs who feel uncomfortable prescribing aspirin in this group of patients, the researchers reported in the British Journal of General Practice.
In 2020, the National Institute for Health and Clinical Excellence recommended consideration of a daily aspirin to reduce colorectal cancer risk in people with Lynch syndrome.
The CAPP2 trial published in The Lancet in the same year reported a reduced risk of colorectal cancer among people with Lynch syndrome randomised to 600mg aspirin versus placebo after 10 years.
In the latest study researchers presented GPs with eight vignettes describing a hypothetical patient who had been recommended to take aspirin by a clinical geneticist.
But the scenarios were altered to include or not include the existence of NICE guidance, results from the trial and other information on the risks and benefits of taking aspirin to see what had the most impact on prescribing decisions.
Before taking part in the study, less than half of the GPs were aware of use of aspirin in this group of patients and just over 17% of the GPs were aware of the NICE guidance, the researchers found.
Among those who were unwilling to prescribe after taking part in the exercise, nine in ten of were concerned about the harms of aspirin and four in five were concerned about prescribing ‘off-label’, the results showed.
The researchers noted that the study only measured GPs’ hypothetical willingness to prescribe aspirin and prescribing behaviour may be different when it comes to clinical practice.
But they concluded formal training, educational events and raising awareness in GP magazines may help to increase the proportion of GPs happy to prescribe aspirin in patients with Lynch syndrome.
Strategies to increase patient knowledge could also help overcome barriers, they added.
Kelly Lloyd, study lead and postgraduate researchers from the Leeds Institute of Health Sciences said: ‘We want all GPs to have effective conversations with their patients who have Lynch syndrome about the benefits and harms of taking aspirin.
‘Nearly one in four GPs don’t feel fully equipped to have conversations with their patients about aspirin, which is why we want to see more training made available to ensure all GPs are aware of the guidance and can help their patients benefit from it.’
She added: ‘Our findings suggest one approach to supporting GPs’ discussions with patients on the benefits and harms of aspirin for preventive therapy is increasing awareness on using aspirin for this purpose through formal training, educational events, and GP magazines.
‘We hope that these findings can help to effectively implement the NICE guidance recommending aspirin into routine clinical practice.’
Aspirin is absurdly cheap, perhaps people could just buy a packet otc?
Tell the gastroenterologist or geneticist to prescribe the first 3 months. Put a box citing NICE guidelines on the letter to remind the poor generalist and we can claim CPD for the ensuing self-training, amongst the million other things in our heads. Empower the patient at diagnosis with the leaflet? But no. Funny that isn’t it? Blame the lonely GP in his box for reluctance.
Is it possible that a fifth of GPs didn’t have a Scooby Doo what Lynch Syndrome is?
Is it a habit of directing brilliant overly-complex films that make no sense?
Or perhaps a propensity to form angry mobs to hunt down alleged perpetrators?
Fortunately a Wiki search told me Lynch Syndrome is in fact HNPCC (a now redundant term, apparently), otherwise I would have been just as baffled.
As a rule it’s probably better not to prescribe for syndromes you’ve never heard of.
Entering research for some is becoming the evolving method of avoiding clinical practice,avoiding responsibility for any action and minimising patient contact for yourself while making pronouncements about issues that are palmed off for others to deal with!
It strikes me that the study authors appear to be ignoring their own findings.
If the cause of GPs being reluctant to prescribe is NOT a lack of training, then imposing mandatory training will NOT change the finding, it will just alienate GPs.
First, they should consider :
Is prescribing of prophyllactic aspirin supported by the local Consultants?
is prescribing of aspirin forbidden by LHB in favour of OTC?
Is prescribing of aspirin supported by it being mandatorily added to the licence for all forms of aspirin?
Is aspirin going to cause side effects?
Who will notice if the patient develops a contraindication, and stop the aspirin?
Step 1 – allow solicitors, GMC, PAG, CQC, Ombudsman to crucify anyone who deviates from the safe centre of the herd.
Step 2 – look on in slack-jawed confusion as GPs show no enthusiasm to deviate from the safe centre of the herd.
No. I can’t think of any way these could be linked, or any potential solution. Perhaps employing a Director of Lived Experience is the answer?
Specialists are most likely to miss picking up Lynch syndrome, but the article ends up being about GPs?