An Attempt to Increase Compliance to Cervical Cancer Screening through General Practitioners

Abstract

The authors report the results of a campaign aimed at increasing compliance to cervical cancer screening by promoting general practitioners' (GPs) cooperation. Different types of intervention were tested, namely mailing lists of non responders to the GP, visiting the GP at the office, or both. No active intervention was made in a sample of GPs who served as a control group. Overall 288 GPs assisting 75,853 women aged 25 to 59 were enrolled in the study. Compliance before and after the campaign was studied and the association between compliance and different variables such as age, residence and type of intervention was tested by univariate and multivariate analysis. The proportion of previous non responders who performed a Pap test after the campaign was 6.7%, the response being dependent on age (25-29 = 11.5%, 30-39 = 8.8%, 40-49 = 6.5%, 50-59 = 4.2%) and place of residence (urban = 7.2%, suburban = 5.9%, rural = 4.0%). Compliance was better in the case of the active campaign (list mailing = 8.3%, visit = 7.0%, list + visit = 7.2%) with respect to controls (2.9%) although no significant differences were detected between different types of active intervention. Compliance to cervical cancer screening may be increased by promoting GPs cooperation but the benefit is limited. Mailing lists of non responders was found the most cost effective policy in this study.

The determinants of screening uptake and interventions for increasing uptake: a systematic review.

“…A large proportion (21/65, 32%) of the included studies failed to provide details of nonparticipation rates or how their study sample was derived from the target population. [60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77] For those studies (44/65, 68%) where sufficient information was available, the non-participation rates varied between 0% and 86%, with the majority of studies having non-participation rates of between 1% and 49% (26/65, 40%). A 0% non-participation rate was only achieved in 11 out of 64 studies (17%).…”

“…A number of the other studies also focused on national screening programmes using call-recall systems, but this was not mentioned as a contributing factor in their non-participation rates. 62,71,79 Blinding 'Blinding' refers to concealing data, on the presence or absence of the determinants being assessed, from the investigators that are measuring the outcome of screening uptake. Only two of the studies stated that the investigator was blinded, and these were both controlled studies.…”

“…105,115 Seven of 65 studies (10%) failed to report the method used to determine screening uptake. 62,65,71,84,94,97,122…”

“…73,76,91,94,101,106,113,118,121 It was not clear in eight of 64 studies (12%) how many of the original participants were included in the final analysis. [62][63][64][65]74,84,111,120 Adequate method used to deal with participants lost to follow-up…”

“…Twelve studies that investigated determinants of the uptake of cervical cancer screening were identified, including eight RCTs, 65,71,80,86,87,103,115,122 three controlled trials 62,79,84 and one quasi-RCT. 89 Seven of the trials were based in the USA, where screening is usually provided by medical insurance companies or paid for by the individuals themselves.…”