Examining the information needed for acceptance of deintensified screening programmes: qualitative focus groups about cervical screening in Australia

Abstract

ObjectivesGiven the changing understanding of overdiagnosis of screen detected cancers and advances in technology to detect and prevent cancer, updating and scaling back cancer screening programmes is becoming increasingly necessary. The National Cervical Screening Programme (NCSP) in Australia was recently deintensified, with the changes implemented in December 2017. This study examines women’s understanding and acceptance of the renewed screening protocol and how such changes can be communicated more effectively.DesignFocus groups structured around a presentation of information about the renewed NCSP, with discussions of the information facilitated throughout. Qualitative data analysis was conducted.SettingAustraliaParticipantsSix focus groups were conducted in November 2017 with a community sample of 49 women aged 18–74.ResultsWomen demonstrated little or no awareness of the upcoming screening changes in the period just before they occurred. Women expressed most concern and fear that the increased screening interval (from 2 to 5 years) and later age of first screening (from age 18 to 25 years) could lead to missing cancers. Concerns about exit testing were less common. Understanding of the natural history and the prevalence of both human papillomavirus and cervical cancer, and the nature of the new test (catching it ‘earlier’) was key to alleviate concerns about the increased screening interval.ConclusionsDeintensifying screening programmes should be accompanied by clear and coherent communication of the changes, including the rationale behind them, to limit concerns from the public and facilitate acceptance of renewed programmes. In this case, understanding the biology of cervical cancer was crucial.

Women’s experiences of the renewed National Cervical Screening Program in Australia 12 months following implementation: a qualitative study

“…This is important as our previous research showed that communicating to women about the change in test can then help provide reassurance and understanding to women about some of the other changes to the programme. 21 …”

Getting the timing right: Women’s views on the best time to announce changes to cancer screening policy recommendations

“…As previously described ( Dodd et al, 2019 ), six focus groups were conducted with women aged 18–74 across three locations in Sydney, Australia. Each group consisted of 5–10 women, divided by eligible age ranges (18–30, 31–50 and 51–74 years) for both the previous (1991–2017, age 18–69) and current (2017-present, age 25–74 years) NCSP.…”

“…An initial announcement of the changes was made by the Australian government in April 2014, but no mass awareness campaign informed the public prior to its implementation. A petition against the changes in early 2017, started by an Australian woman who was concerned and worried after being informed about the changes by her GP, gathered over 70,000 signatures, suggesting that there was a considerable amount of resistance ( Obermair et al, 2018 ), which appeared to arise due to a lack of knowledge and understanding about the reasons behind the changes ( Dodd et al, 2019 ). The NCSP used to recommend screening women aged 18–69 every two years with cytology-based screening.…”

“…Limited awareness of these updated recommendations were recorded in focus groups of Australian women held in the month prior to their implementation ( Dodd et al, 2019 ). Using the case of Australia’s NCSP, the aim of this study was to consider women’s views on how similar changes to cancer screening programs could be more effectively communicated to the public in the future.…”

Levels of anxiety and distress following receipt of positive screening tests in Australia’s HPV-based cervical screening programme: a cross-sectional survey

“…Focus group findings supported the need for women to have clear and coherent information prior to implementing significant programme changes. They identified what information women sought, as well as what information is helpful in explaining the changes to the programme 8. Together these studies suggest that many Australian women may have suboptimal understanding of the renewed NCSP.…”