Completing the Cervical Screening Pathway: Factors that Facilitate the Increase of Self-Collection Uptake among Under-Screened and Never-Screened Women, an Australian Pilot Study

McLachlan, Elspeth M.; Anderson, Shoana; Hawkes, David; Saville, Marion; Arabena, Kerry

doi:10.3747/co.25.3916

Cited by 33 publications

(81 citation statements)

References 16 publications

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“…29 Five studies employed a multimethod or mixed methods design. 47 67–70 A total of 58 studies employed a quantitative approach: 47 cross-sectional studies, 41–46 48 50–63 65 66 71–94 two pre–post surveys, 64 95 eight RCTs 33–40 and one prospective cohort. 49 Quantitative studies examined a wide range of end users, including underscreened and vulnerable subpopulations such as women living HIV, 51 60 61 transmales 62 and female sex workers.…”

Section: Resultsmentioning

confidence: 99%

“…Other studies suggested strategies to increase end user’s confidence in performing self-sampling correctly. 47 55 70 In clinical settings, end users cited the important role of a trusted healthcare provider in fielding questions and providing reassurance that sampling was done correctly. 27 30 47 70 In addition, clear, step-by-step instructions with illustrations in the appropriate language were suggested as methods to facilitate self-sampling and improve end users’ confidence.…”

Section: Resultsmentioning

confidence: 99%

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HPV self-sampling for cervical cancer screening: a systematic review of values and preferences

et al. 2021

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IntroductionThe WHO recommends human papillomavirus (HPV) cervical self-sampling as an additional screening method and HPV DNA testing as an effective approach for the early detection of cervical cancer for women aged ≥30 years. This systematic review assesses end user’s values and preferences related to HPV self-sampling.MethodsWe searched four electronic databases (PubMed, Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature and Embase) using search terms for HPV and self-sampling to identify articles meeting inclusion criteria. A standardised data extraction form was used to capture study setting, population, sample size and results related to values and preferences.ResultsOf 1858 records retrieved, 72 studies among 52 114 participants published between 2002 and 2018 were included in this review. Almost all studies were cross-sectional surveys. Study populations included end users who were mainly adolescent girls and adult women. Ages ranged from 14 to 80 years. Most studies (57%) were conducted in high-income countries. Women generally found HPV self-sampling highly acceptable regardless of age, income or country of residence. Lack of self-confidence with collecting a reliable sample was the most commonly cited reason for preferring clinician-collected samples. Most women preferred home-based self-sampling to self-sampling at a clinic. The cervical swab was the most common and most accepted HPV DNA sampling device.ConclusionsHPV self-sampling is generally a highly accepted method of cervical cancer screening for end users globally. End user preferences for self-sampling device, method and setting can inform the development of new and expanded interventions to increase HPV screening.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

HPV self-sampling for cervical cancer screening: a systematic review of values and preferences

et al. 2021

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“…Primary care providers could verify the screening status of their patients belonging to the target screening population and offer self sampling kits to those who have not been screened recently. 129 130 Primary care providers could be an effective alternative in settings where mailing sampling kits as part of an organized screening program is not feasible and door-to-door invitation is too costly. Self sampling could also become the new paradigm for primary cervical cancer screening in the general population as an alternative for the collection of a clinician sample.…”

Section: Discussionmentioning

confidence: 99%

Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses

Arbyn

Smith

Temin

et al. 2018

BMJ

573

731

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ObjectiveTo evaluate the diagnostic accuracy of high-risk human papillomavirus (hrHPV) assays on self samples and the efficacy of self sampling strategies to reach underscreened women.DesignUpdated meta-analysis.Data sourcesMedline (PubMed), Embase, and CENTRAL from 1 January 2013 to 15 April 2018 (accuracy review), and 1 January 2014 to 15 April 2018 (participation review).Review methodsAccuracy review: hrHPV assay on a vaginal self sample and a clinician sample; and verification of the presence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) by colposcopy and biopsy in all enrolled women or in women with positive tests. Participation review: study population included women who were irregularly or never screened; women in the self sampling arm (intervention arm) were invited to collect a self sample for hrHPV testing; women in the control arm were invited or reminded to undergo a screening test on a clinician sample; participation in both arms was documented; and a population minimum of 400 women.Results56 accuracy studies and 25 participation trials were included. hrHPV assays based on polymerase chain reaction were as sensitive on self samples as on clinician samples to detect CIN2+ or CIN3+ (pooled ratio 0.99, 95% confidence interval 0.97 to 1.02). However, hrHPV assays based on signal amplification were less sensitive on self samples (pooled ratio 0.85, 95% confidence interval 0.80 to 0.89). The specificity to exclude CIN2+ was 2% or 4% lower on self samples than on clinician samples, for hrHPV assays based on polymerase chain reaction or signal amplification, respectively. Mailing self sample kits to the woman’s home address generated higher response rates to have a sample taken by a clinician than invitation or reminder letters (pooled relative participation in intention-to-treat-analysis of 2.33, 95% confidence interval 1.86 to 2.91). Opt-in strategies where women had to request a self sampling kit were generally not more effective than invitation letters (relative participation of 1.22, 95% confidence interval 0.93 to 1.61). Direct offer of self sampling devices to women in communities that were underscreened generated high participation rates (>75%). Substantial interstudy heterogeneity was noted (I2>95%).ConclusionsWhen used with hrHPV assays based on polymerase chain reaction, testing on self samples was similarly accurate as on clinician samples. Offering self sampling kits generally is more effective in reaching underscreened women than sending invitations. However, since response rates are highly variable among settings, pilots should be set up before regional or national roll out of self sampling strategies.

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“…This in turn negatively affected their confidence in explaining the NCSP changes to women and potentially missed opportunities for cervical screening via self‐collection. A growing body of evidence demonstrates the potential for self‐collection to overcome barriers to clinician‐collected cervical screening and improve participation in Australia 26-28 and among Indigenous women in Aotearoa New Zealand and Canada 29-31 . Currently, there are only two laboratories in Australia that support analysis of self‐collected samples 32 .…”

Section: Discussionmentioning

confidence: 99%

Health care provider perspectives on cervical screening for Aboriginal and Torres Strait Islander women: a qualitative study

Jaenke

Butler

Condon

et al. 2021

Australian and New Zealand Journal of Public Health

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Objective: To investigate perspectives of primary health care providers (HCPs) on providing cervical screening for Aboriginal and Torres Strait Islander women, who experience a higher burden of cervical cancer than other Australian women. Methods: Semi‐structured interviews with 13 HCPs from four Australian Indigenous primary health care centres (PHCCs). Transcripts were thematically analysed. Results: HCPs discussed the need to approach cervical screening with sensitivity to women's emotional and cultural needs and sustaining relationships built on trust and respect. HCPs reported challenges in promoting screening to Aboriginal and Torres Strait Islander women due to cumbersome systems, competing clinical priorities, workforce capacity limitations and specific challenges associated with implementing the renewed National Cervical Screening Program. Conclusions: In practice, HCPs experience several challenges to delivering cervical screening. Understanding HCPs’ perspectives on their approach to cervical screening delivery, and the systems in which this occurs, can help to ensure that they receive adequate support and resources to deliver cervical screening to Aboriginal and Torres Strait Islander women. Implications for public health: It is important that HCPs adopt a multi‐faceted, person‐centred approach to cervical screening that is responsive to women's needs and that works synchronously with supportive PHCC services and systems and the National Cancer Screening Register.

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Completing the Cervical Screening Pathway: Factors that Facilitate the Increase of Self-Collection Uptake among Under-Screened and Never-Screened Women, an Australian Pilot Study

Abstract: A well-implemented process, led by trusted, knowledgeable, and engaged health care professionals who can provide appropriate support and information, can assist under-screened and never-screened women to complete the hpv self-collection pathway successfully.

Cited by 33 publications

References 16 publications

HPV self-sampling for cervical cancer screening: a systematic review of values and preferences

HPV self-sampling for cervical cancer screening: a systematic review of values and preferences

Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses

Health care provider perspectives on cervical screening for Aboriginal and Torres Strait Islander women: a qualitative study

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