Implementation of Australia’s primary human papillomavirus (HPV) cervical screening program: The STakeholders Opinions of Renewal Implementation and Experiences Study

Brotherton, Julia M L; McDermott, Tracey; Smith, Megan A.; Machalek, Dorothy A; Shilling, Hannah; Prang, Khic-Houy; Jennett, Chloe J; Nightingale, Claire; Zammit, Claire; Pagotto, Amy; Rankin, Nicole; Kelaher, Margaret

doi:10.1016/j.pmedr.2023.102213

Cited by 4 publications

(5 citation statements)

References 18 publications

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“…The data reported in this paper focuses on the impact of the renewal on the pathology sector, with ndings about the impact of the renewal on other stakeholder groups reported separately. (13,14) Ethical considerations…”

Section: Discussionmentioning

confidence: 99%

“…(19,20) Our study ndings corroborate that the strength of the evidence base was an important enabler across the range of key stakeholders involved in the implementation in Australia. (13,14) A recent systematic review identi ed 25 high-income countries that have adopted recommendations for primary HPV screening as part of the national program, with the majority planning to transition from cytology. (21) Our ndings are of signi cant relevance to these countries, as the strength of the evidence base may also have signi cant implications for the perceived acceptability and appropriateness of such transitions.…”

Section: Discussionmentioning

confidence: 99%

“…This qualitative study consisted of semi-structured interviews conducted with key stakeholders directly and indirectly involved in the implementation of Renewal. (13,14) Key stakeholders were interviewed about their perspectives and experiences of being involved in the implementation of the Renewal, including the associated barriers, challenges, and enablers.…”

Section: Methodsmentioning

confidence: 99%

“…The key implementation challenges across several Program stakeholder groups have been described previously. (13,14) This study aimed to understand the early impacts of Renewal and its implementation on the pathology sector.…”

Section: Introductionmentioning

confidence: 99%

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The early impacts of primary HPV cervical screening implementation in Australia on the pathology sector: a qualitative study

Bavor

Brotherton²,

Smith

et al. 2023

Preprint

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Background The transition of Australia’s National Cervical Screening Program from cytology to a molecular test for human papillomavirus (HPV) (locally referred to as the ‘Renewal’), including a longer five-year interval and older age at commencement, significantly impacted all sectors of program delivery. The Renewal had major implications for the roles and requirements of pathology laboratories providing services for the Program. This study aimed to understand the early impacts of the Renewal and its implementation on the pathology sector. Methods Semi-structured qualitative interviews were conducted with key stakeholders (N = 49) involved in the STakeholder Opinions of Renewal Implementation and Experiences Study (STORIES), 11–20 months after the program transition. A subset of interviews (N = 24) that discussed the pathology sector were analysed using inductive thematic analysis. Results Four overarching themes were identified: implementation enablers, challenges, missed opportunities, and possible improvements. Participants believed that the decision to transition to primary HPV screening was highly acceptable and evidence-based, but faced challenges due to impacts on laboratory infrastructure, resources, staffing, and finances. These challenges were compounded by unfamiliarity with new information technology (IT) systems and the new National Cancer Screening Register (‘Register’) not being fully functional by the date of the program transition. The limited availability of self-collection and lack of standardised fields in pathology forms were identified as missed opportunities to improve equity in the Program. To improve implementation processes, participants suggested increased pathology sector involvement in planning was needed, along with more timely and transparent communication from the Government, and clearer clinical management guidelines. Conclusion The transition to primary HPV screening had a significant and multifaceted impact on the Australian pathology sector reflecting the magnitude and complexity of the Renewal. Strategies to support the pathology sector through effective change management, clear, timely, and transparent communication, as well as adequate funding sources will be critical for other countries planning to transition cervical screening programs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The early impacts of primary HPV cervical screening implementation in Australia on the pathology sector: a qualitative study

Bavor

Brotherton²,

Smith

et al. 2023

Preprint

Self Cite

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“…Yet the findings in this study are consistent with findings by Brotherton et al, who described that several years after Australia changed its national cervical cancer guidelines, providers were generally supportive of the new guidelines but voiced concerns about the appropriateness of the guidelines for special populations, concerns about missing cases of cervical cancer, and lack of system support, among others. 29 Thus, continuing long-term surveillance of cancer cases to demonstrate the safety of new guidelines is paramount.…”

mentioning

confidence: 99%

Attitudes toward the American Cancer Society’s 2020 cervical cancer screening guidelines: A qualitative study of a national sample of US clinicians

Michel,

Fontenot,

Fuzzell

et al. 2024

Cancer

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BackgroundThe 2020 American Cancer Society (ACS) guidelines are the most recent national guidelines for cervical cancer screening. These guidelines propose two major changes from current practice: initiating screening at age 25 years and using primary human papillomavirus (HPV) testing. Adoption of guidelines often occurs slowly, and therefore understanding clinician attitudes is important to facilitate practice change.MethodsInterviews with a national sample of clinicians who perform cervical cancer screening in a variety of settings explored attitudes toward the two major changes from the 2020 ACS cervical cancer screening guidelines. Clinicians participated in 30‐ to 60‐min interviews exploring their attitudes toward various aspects of cervical cancer screening. Qualitative analysis was performed.ResultsSeventy clinicians participated from across the United States. Few respondents were initiating screening at age 25 years, and none were using primary HPV testing. However, over half would be willing to adopt these practices if supported by scientific evidence and recommended by professional medical organizations. Barriers to adoption included the lack of endorsement by professional societies, lack of laboratory availability and insurance coverage, limited autonomy within large health care systems, and concerns related to missed disease.ConclusionsFew clinicians have adopted screening initiation or primary HPV testing, as recommended by the 2020 ACS guidelines, but over half were open to adopting these changes. Implementation may be facilitated via professional organization endorsement, clinician education, and laboratory, health care system, and insurance support.Plain Language Summary In 2020, the American Cancer Society (ACS) released updated guidelines for cervical cancer screening. The main changes to current practices were to initiate screening at age 25 years instead of age 21 years and to screen using primary human papillomavirus (HPV) testing rather than cytology alone or in combination with HPV testing. We performed in‐depth interviews with 70 obstetrics and gynecology, family medicine, and internal medicine physicians and advanced practice providers about their attitudes toward these guidelines. Few clinicians are following the 2020 ACS guidelines, but over half were open to changing practice if the changes were supported by evidence and recommended by professional medical organizations. Barriers to adoption included the lack of endorsement by professional medical organizations, logistical issues, and concerns about missed disease.

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How Does Transitioning to Primary Human Papillomavirus Screening Impact Colposcopy Services? Lessons From an Australian National Program

Jennett,

Smith,

Machalek

et al. 2025

J Low Genit Tract Dis

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Objective In 2017, Australian's National Cervical Screening Program changed from 2-yearly cytology to 5-yearly primary human papillomavirus (HPV) testing. The Stakeholder Opinions of Renewal Implementation and Experiences Study (STORIES) aimed to capture stakeholder perspectives during implementation of the renewed National Cervical Screening Program. Materials and Methods Qualitative semistructured interviews were conducted with key National Cervical Screening Program stakeholders 11–20 months following the change, either face-to-face, online, or via phone. Data related to colposcopy services were thematically analyzed using Proctor's conceptual framework for implementation outcomes. Results We identified 4 overarching themes: non-adherence to guidelines, lack of preparedness, unintended consequences, and mitigation strategies. While an initial increase in colposcopy referral was expected following transition, many stakeholders found increased referrals to be inequitably spread across services and exacerbated by confusion about, or overuse of testing for, symptoms. Conclusions The study provides the first assessment of stakeholder perceptions and experiences relating to colposcopy services during a transition from cytology to HPV screening. Significant preparation is required to ensure equitable and timely access to colposcopy when transitioning cervical screening programs, including wide stakeholder communication to build confidence; clear guidelines, especially around symptoms; and adequate resourcing for colposcopy services to meet projected referral rates.

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Implementation of Australia’s primary human papillomavirus (HPV) cervical screening program: The STakeholders Opinions of Renewal Implementation and Experiences Study

Cited by 4 publications

References 18 publications

The early impacts of primary HPV cervical screening implementation in Australia on the pathology sector: a qualitative study

The early impacts of primary HPV cervical screening implementation in Australia on the pathology sector: a qualitative study

Attitudes toward the American Cancer Society’s 2020 cervical cancer screening guidelines: A qualitative study of a national sample of US clinicians

How Does Transitioning to Primary Human Papillomavirus Screening Impact Colposcopy Services? Lessons From an Australian National Program

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