Inequalities in the use of breast cancer prevention services

Lead Research Organisation: University of Leeds
Department Name: Sociology & Social Policy

Abstract

The project will investigate the psychological factors underpinning women's decision to engage with breast cancer prevention services, which is currently under explored. The main aims of the research are to investigate inequalities in breast cancer prevention services use and the psychological factors underpinning these decisions. Another aim of the project will be to develop a theory-based support tool for women making decisions about breast cancer prevention. The supervisor, Dr Smith, has written the project's full proposal.

Studentship Projects

Project Reference Relationship Related To Start End Student Name
ES/P000746/1 30/09/2017 29/09/2027
2113215 Studentship ES/P000746/1 30/09/2018 31/12/2022 Kelly Lloyd
 
Description The first study in my PhD was a systematic review that aimed to synthesise the quantitative and qualitative data on uptake and adherence behaviours related to aspirin for cancer prevention, investigate the factors affecting decisions to use aspirin, and examine healthcare providers' attitudes towards implementing aspirin in clinical care.

Summary of results:
Searches were conducted in the multiple databases (e.g. EMBASE, MEDLINE, clinical trial registries). A total of 38 studies were included. Overall, in the review we found that most people who were eligible and offered participation in an aspirin trial accepted. The majority of participants also reported a good level of adherence on a day-to-day basis. We found high levels of short-term aspirin persistence, but evidence was mixed for long-term persistence. No studies examined uptake and adherence in routine care, and minimal research investigated the factors associated with using aspirin. No qualitative studies were identified. We found that there is substantial scope for behavioural research into the barriers and facilitators to implementing aspirin for preventive therapy into clinical care.

The second PhD was a qualitative interview study. We conducted interviews exploring the facilitators and barriers to implementing aspirin for preventive therapy into clinical practice among people with Lynch syndrome and healthcare providers. The interview topic guides were developed to cover the 14 domains in the Theoretical Domains Framework. Recruitment opened in November 2020, and closed in November 2021. Overall, 15 people with Lynch syndrome and 23 healthcare professionals were recruited and interviewed.

Summary of results:
All healthcare providers viewed general practitioners (GPs) as responsible for prescribing aspirin. However, GPs were unfamiliar with using aspirin for preventive therapy, and were concerned about prescribing aspirin at higher doses (300-600mg). To support decision-making, GPs wanted clarification from specialist clinicians (e.g. clinical geneticists) on the evidence and appropriate dose to prescribe. Not all participants with Lynch syndrome received information on aspirin from their healthcare provider, and several were unsure who to discuss aspirin further with. We concluded that coordinated and multilevel strategies are needed, addressing the needs of both GPs and people with Lynch syndrome, to ensure consistent implementation of national guidance on aspirin for preventive therapy.
Exploitation Route The UK National Institute for Health and Care Excellence (NG151) recommends considering daily aspirin for people with Lynch syndrome to reduce colorectal cancer risk. However, patients and their healthcare providers considering preventive therapy need to negotiate complex decisions that weigh up potential benefits and harms. Previously, this was an underexplored area in behavioural research. Our findings provide unique evidence on the facilitators and barriers to implementing aspirin for cancer preventive therapy into clinical practice. There is potential for these findings to be utilised by both researchers and policy makers.
Sectors Healthcare
 
Description NIHR Clinical Research Network Yorkshire and Humber Travel Bursary
Amount £250 (GBP)
Organisation National Institute for Health Research 
Department Clinical Research Network: Yorkshire and Humber
Sector Academic/University
Country United Kingdom
Start 12/2019 
End 03/2020
 
Description RTSG Top-Up
Amount £3,600 (GBP)
Organisation White Rose University Consortium 
Sector Academic/University
Country United Kingdom
Start 05/2021 
End 12/2022
 
Title Qualitative study exploring the barriers and facilitators to using and recommending aspirin for cancer prevention - qualitative interview data 
Description This dataset comprises a subset of the interviews described below: 12 Lynch syndrome interviews, and 8 GP interviews. The interviews are stored in a restricted access database. Background: The National Institute for Health and Care Excellence (NG151) recommends considering daily aspirin for people with Lynch syndrome to reduce colorectal cancer risk. However, patients and their healthcare providers considering preventive therapy need to negotiate complex decisions that weigh up potential benefits and harms. Method: We conducted semi-structured interviews to explore the barriers and facilitators to using aspirin for preventive therapy. We recruited 15 people with Lynch syndrome, and 23 healthcare providers across multiple professions in primary and specialist care in the United Kingdom. Interview schedules were informed by the Theoretical Domains Framework. 
Type Of Material Database/Collection of data 
Year Produced 2022 
Provided To Others? Yes  
Impact This data was used in our preprint manuscript: https://psyarxiv.com/swvf9/ 
URL https://archive.researchdata.leeds.ac.uk/923/