Improving the uptake of cervical screening in pregnant and recently postnatal women: a quality improvement project

Coleridge, Sarah; Wiggans, Alison J; Nelissen, Ellen; Bethune, Rob; Blackwell, Richard E.; Bryant, Andrew; Morrison, Jo

doi:10.1136/bmjoq-2021-001709

Cited by 4 publications

(3 citation statements)

References 19 publications

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“…French hospital-based studies have found similar rates of failure to catch up during pregnancy (from 53 to 61%) [ 39 – 41 ], but our work is the first study to describe this phenomenon among a national sample of pregnant women. In the UK, Coleridge et al found that nearly half (47.3%) of a sample of 260 pregnant women were overdue for cervical screening and 74% were not caught up during either their pregnancy or the first 6 months postpartum [ 42 ]. In Brazil, Terlan and Cesar have observed that, despite prenatal visits, 21.6% pregnant women did not undergo the Pap smears they should have had [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Women’s country of birth and failure to catch up an overdue cervical cancer cytological screening participation during pregnancy in France, an observational study based on survey sources

Lyonnais,

Vigoureux,

Blondel

et al. 2024

BMC Cancer

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Background Cervical cancer is the fourth most common cancer among women worldwide, both for incidence and mortality. Prevention relies on screening with a Pap test to detect precancerous lesions, which can then be treated. Access to this screening is currently both improvable and inequitable. Pregnancy may be an ideal moment for women to catch up on their overdue cervical cancer screening. In the general population, women's risk of not being screened is associated with their place of birth and other social factors; this may be true as well among pregnant women. Our objective was to study the association between women's place of birth and their failure to catch up with this screening during pregnancy. Methods The 2016 French National Perinatal Survey included 13,147 women who gave birth after 21 weeks of gestation. The association between their place of birth and failure to catch up on this screening (defined by the absence of a Pap test during pregnancy for women overdue for it) was adjusted for age, parity, education level, health insurance, and when they began prenatal care with logistic regression models. Results Among the women for whom screening was then recommended, 49% were not up to date at the start of pregnancy, and of these, 53% were not caught up before delivery. After adjustment for other risk factors, maternal place of birth was not associated with a higher risk of failure to catch up with this screening during pregnancy. However, factors identified as associated with this risk included a low education level and late start of prenatal care. Conclusion About half of women overdue for cervical cancer screening did not catch up with it during their pregnancy. Professionals should pay special attention to women with lower education levels and late initiation of prenatal care, who constitute a group at high risk of not catching up on this screening during pregnancy.

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Section: Discussionmentioning

confidence: 99%

Women’s country of birth and failure to catch up an overdue cervical cancer cytological screening participation during pregnancy in France, an observational study based on survey sources

Lyonnais,

Vigoureux,

Blondel

et al. 2024

BMC Cancer

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“…Oyegbite et al showed that a nurse contacting 120 patients overdue for CCS in a small practice in northwest England increased CCS rates versus texting, but the effort required to achieve this increase was unsustainable ( Oyegbite et al, 2021 ). Another study of 260 patients showed a 8% increase in CCS for pregnant and postpartum patients by introducing a package of CCS information, targeted education, and widening access to screening appointments ( Coleridge et al, 2022 ). Other research on CCS during the COVID-19 pandemic used different changes in workflow to improve screening rates.…”

Section: Discussionmentioning

confidence: 99%

Electronic data review, client reminders, and expanded clinic hours for improving cervical cancer screening rates after the COVID-19 pandemic shutdowns: A multicomponent quality improvement program

Ghosh,

Fantes,

Leschly

et al. 2023

eLife

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Background:To improve cervical cancer screening (CCS) rates, the East Boston Neighborhood Health Center implemented a quality improvement initiative from March to August 2021.Methods:Staff training was provided. A 21-provider team validated overdue CCS indicated by electronic medical record data. To improve screening, CCS-only sessions were created during regular clinic hours (n = 5) and weekends/evenings (n = 8). Patients were surveyed on their experience.Results:A total of 6126 charts were reviewed. Of the list of overdue patients, outreach was performed on 1375 patients to schedule the 13 sessions. A total of 459 (33%) patients completed screening, 622 (45%) could not be reached, and 203 (15%) canceled or missed appointments. The proportion of total active patients who were up to date with CCS increased from 68% in March to 73% in August 2021. Survey results indicated high patient satisfaction, and only 42% of patients would have scheduled CCS without outreach.Conclusions:The creation of a validated patient chart list and extra clinical sessions devoted entirely to CCS improved up-to-date CCS rates. However, high rates of unsuccessful outreach and cancelations limited sustainability. This information can be used by other community health centers to optimize clinical workflows for CCS.Funding:All funding was internal from the EBNHC Adult Medicine, Family Medicine, and Women’s Health Departments.

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“…Ogebyte et al showed that a nurse contacting 120 patients overdue for CCS in a small practice in northwest England increased CCS rates versus texting, but the effort required to achieve this increase was unsustainable (Ogebyte, 2021). Another study of 260 patients showed a 8% increase in CCS for pregnant and postpartum patients by introducing a package of CCS information, targeted education, and widening access to screening appointments (Coleridge, 2022). Other research on CCS during the COVID-19 pandemic used different changes in workflow to improve screening rates.…”

Section: Regular Clinic Hoursmentioning

confidence: 99%

Electronic data review, client reminders, and expanded clinic hours for improving cervical cancer screening rates after COVID-19 pandemic shutdowns: a multi-component quality improvement program

Ghosh

Fantes

Leschly

et al. 2023

Preprint

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Objective: To improve cervical cancer screening (CCS) rates, the East Boston Neighborhood Health Center (EBNHC) implemented a Quality Improvement (QI) initiative from March to August 2021.Methods: Staff training was provided. A 21-provider team validated overdue CCS indicated by electronic medical record data. To improve screening, CCS-only sessions were created during regular clinic hours (n=5) and weekends/evenings (n=8). Patients were surveyed on their experience.Results: 6126 charts were reviewed. Of the list of overdue patients, outreach was performed to 1375 patients to schedule the 13 sessions. A total of 459 (33%) of patients completed screening, 622 (45%) could not be reached, and 203 (15%) canceled or missed appointments. The proportion of total active patients who were up to date with CCS increased from 68% in March to 73% in August 2021. Survey results indicated high patient satisfaction, and only 42% of patients would have scheduled CCS without outreach.Conclusions: The creation of a validated patient chart list and extra clinical sessions devoted entirely to CCS improved up-to-date CCS rates. However, high rates of unsuccessful outreach and cancelations limited sustainability. This information can be used by other community health centers to optimize clinical workflows for CCS.<br /><br />Funding: All funding was internal from EBNHC Adult Medicine, Family Medicine, and Women’s Health Departments

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Improving the uptake of cervical screening in pregnant and recently postnatal women: a quality improvement project

Cited by 4 publications

References 19 publications

Women’s country of birth and failure to catch up an overdue cervical cancer cytological screening participation during pregnancy in France, an observational study based on survey sources

Women’s country of birth and failure to catch up an overdue cervical cancer cytological screening participation during pregnancy in France, an observational study based on survey sources

Electronic data review, client reminders, and expanded clinic hours for improving cervical cancer screening rates after the COVID-19 pandemic shutdowns: A multicomponent quality improvement program

Electronic data review, client reminders, and expanded clinic hours for improving cervical cancer screening rates after COVID-19 pandemic shutdowns: a multi-component quality improvement program

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