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.
People |
ORCID iD |
| Kelly Lloyd (Student) |
 http://orcid.org/0000-0002-0420-2342
|
Publications
Lloyd K
(2023)
GPs' willingness to prescribe aspirin for cancer preventive therapy in Lynch syndrome: a factorial randomised trial investigating factors influencing decisions
in British Journal of General Practice
Lloyd KE
(2022)
Aspirin use for cancer prevention: A systematic review of public, patient and healthcare provider attitudes and adherence behaviours.
in Preventive medicine
Lloyd KE
(2022)
Barriers and facilitators to using aspirin for preventive therapy: a qualitative study exploring the views and experiences of people with Lynch syndrome and healthcare providers.
in Hereditary cancer in clinical practice
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 | Aspirin is increasingly recommended for cancer preventive therapy. In the United Kingdom (UK), the National Institute for Health and Care Excellence recommends (NG151) aspirin to prevent colorectal cancer in people with Lynch syndrome. Future UK guidance may recommend aspirin for those at population risk of colorectal cancer, similar to Australian guidance. In the thesis, I aimed to investigate the barriers and facilitators affecting use of aspirin for preventive therapy among people with Lynch syndrome and the UK public. I also investigated the barriers to healthcare providers recommending and prescribing aspirin. Study One is a systematic review synthesising the data on behaviour and attitudes in the context of aspirin for cancer prevention. This review found substantial scope for behavioural research into the factors affecting aspirin use. Study Two involved qualitative interviews exploring the views of people with Lynch syndrome and healthcare providers. Patients and GPs had multiple unmet informational needs in decisions concerning aspirin, which are inconsistently supported by current care pathways. Study Three was a mixed methods study recruiting the UK public aged 50 to 70. I observed mixed acceptability towards taking aspirin for colorectal cancer prevention, with concerns among participants on the necessity of the medication and the side-effects. Study Four investigated the optimal type and level of information to communicate with GPs to increase their willingness to prescribe aspirin for a hypothetical patient with Lynch syndrome. Across the factorial trial conditions, I manipulated the presence or absence of three information components: 1) national guidance; 2) trial evidence; 3) information comparing the risks and benefits of aspirin. I found no statistically significant main effects or interactions of the three components on willingness to prescribe. Overall, coordinated and multilevel strategies are warranted, addressing the needs of people with Lynch syndrome, the UK public, and GPs. |
| 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. These findings can be utilised by researchers, patients, healthcare professionals, and policy makers to support the implementation of aspirin for people with Lynch syndrome in the UK. |
| Sectors | Healthcare |
| Description | In my PhD, I investigated decision-making in the context of taking aspirin for cancer prevention. My PhD took place during a vital time point where the findings could support the implementation of new guidance into NHS clinical practice. I identified GPs to be essential for prescribing aspirin for colorectal cancer prevention. However, my data indicated GPs may be reluctant to prescribe, and required further support from specialist hospital care (e.g., clinical genetics). I have disseminated these findings to a wide audience. I have disseminated my findings at the 2022 Joint Dutch/UK Clinical Genetics Societies and Cancer Genetics Group Meeting, and national and international behavioural science conferences. PulseToday, a leading UK GP magazine, reported on the findings from Study 4, where I investigated GPs' willingness to prescribe aspirin in Lynch syndrome (PulseToday, 2022). I was also interviewed to discuss these findings for the British Journal of General Practice podcast series. My PhD research also contributed to development of Yorkshire Cancer Research's Bowel Cancer Improvement Programme Resources, 'Lynch Syndrome and Aspirin Patient Information Sheet & Guidance for GP Prescribing'. |
| First Year Of Impact | 2023 |
| Sector | Healthcare |
| Description | Generating impact to prevent cancer in people with Lynch syndrome |
| Amount | £123,941 (GBP) |
| Funding ID | ES/Y00759X/1 |
| Organisation | Economic and Social Research Council |
| Sector | Public |
| Country | United Kingdom |
| Start | 09/2023 |
| End | 11/2024 |
| Description | NIHR Clinical Research Network Yorkshire and Humber Travel Bursary |
| Amount | £250 (GBP) |
| Organisation | National Institute for Health and Care 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 | A factorial randomised trial investigating factors influencing general practitioners' willingness to prescribe aspirin for cancer preventive therapy in Lynch syndrome: a registered report |
| Description | We investigated the optimal type and level of information to communicate with GPs to increase willingness to prescribe aspirin for colorectal cancer prevention. We recruited GPs in England and Wales (n=672) to an online survey with a 2 by 3 factorial design. GPs were randomised to one of eight vignettes describing a hypothetical patient with Lynch syndrome recommended to take aspirin by a clinical geneticist. Across the vignettes, we manipulated the presence or absence of three types of information: 1) existence of NICE guidance; 2) results from the CAPP2 trial; 3) information comparing risks/benefits of aspirin. We estimated the main effects and all interactions on the primary (willingness to prescribe) and secondary outcomes (comfort discussing aspirin). |
| Type Of Material | Database/Collection of data |
| Year Produced | 2022 |
| Provided To Others? | Yes |
| Impact | The dataset was used for my publication, 'GPs' willingness to prescribe aspirin for cancer preventive therapy in Lynch syndrome: a factorial randomised trial investigating factors influencing decisions', https://bjgp.org/content/73/729/e302 |
| URL | https://archive.researchdata.leeds.ac.uk/1009/ |
| 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/ |
| Description | Aspirin for all? Barriers to prescribing aspirin. April 2023. Lynch Syndrome UK Patient Conference 2023. |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Patients, carers and/or patient groups |
| Results and Impact | I presented my PhD research at the patient conference, Lynch Syndrome UK, where attendees with Lynch syndrome could listen to my findings on GPs' willingness to prescribe aspirin for people with Lynch syndrome. There were over 60 attendees at the event. |
| Year(s) Of Engagement Activity | 2023 |
| Description | Episode 108: What do GPs think about prescribing aspirin to prevent colorectal cancer in Lynch syndrome? BJGP Life. 7th March 2023. |
| Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Media (as a channel to the public) |
| Results and Impact | I discussed my PhD research on the British Journal of General Practice podcast, which was featured on the main website for the journal. This was for Episode 108: What do GPs think about prescribing aspirin to prevent colorectal cancer in Lynch syndrome? BJGP Life. 7th March 2023. |
| Year(s) Of Engagement Activity | 2023 |
| Description | Fifth of GPs reluctant to prescribe aspirin in Lynch syndrome despite NICE guidance. Pulse Today. 2022. |
| Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Media (as a channel to the public) |
| Results and Impact | My PhD research was featured a Pulse Today blog post, 'Fifth of GPs reluctant to prescribe aspirin in Lynch syndrome despite NICE guidance.' Pulse Today is the leading publication for general practitioners (GPs) in primary care in the UK. |
| Year(s) Of Engagement Activity | 2022 |
| Description | Presentation at AsCaP annual meeting |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Other audiences |
| Results and Impact | I presented at the programme funder annual meeting, to an audience of other researchers conducting research funded by the programme, and ideas for new collaborations were discussed following the presentation of my PhD research. |
| Year(s) Of Engagement Activity | 2021 |