Provider beliefs associated with cervical cancer screening interval recommendations: A pilot study in Federally Qualified Health Centers

Abstract

BackgroundAmong providers who serve low-income and uninsured women, resistance to extending the cervical cancer screening interval following normal Pap and co-test results has been documented. Our objective was to examine provider characteristics and beliefs associated with guideline-consistent screening interval recommendations.MethodWe collected cross-sectional survey data between 2009 and 2010 from 82 primary care providers in six Federally Qualified Health Centers in Illinois, USA. The relationships between characteristics, beliefs, and screening interval recommendations (1 year vs. 3 years) were tested with Pearson chi-square, negative binomial and ordered logistic regression.ResultsCompared to providers who recommended annual intervals after a normal co-test, providers who recommended a guideline-consistent (i.e., 3 years) screening interval were significantly more likely to report the goodness, ease, and benefit of their recommendation and perceived encouragement for a 3-year interval from professional organizations and journals (p < .05). Providers who recommended a 3-year interval were also less likely to report that longer intervals increase patient risk for cervical cancer (p < .05). Interval recommendations were not associated with provider specialty, gender, or years in practice.ConclusionMessages that promote the benefits of longer screening intervals after a normal co-test, the natural history of human papillomavirus and cervical cancer, and low risk of developing cancer with a longer interval may be useful to promote evidence-based screening in this population of Federally Qualified Health Center providers. Dissemination of targeted messages through professional journals and specialty organizations should be considered.

Perspectives from health-care providers and women about completing human papillomavirus (HPV) self-testing at home

“…The addition of HPV co-testing to the CC screening recommendations (Moyer, on behalf of the USPSTF, 2012; Saslow et al 2012), the possibility for discordant test results, and the potential for extending the screening interval adds complexity to provider-patient communication about CC screening and test results. Concerns about HPV self-testing and providing results to women are starting to emerge, as well as barriers to testing reported by providers (i.e., liability) and patients (i.e., missing a cancer) (Lin et al 2015; Roland et al 2015). Including HPV self-testing as part of a CC screening program should include: (1) an educational component for women about what will happen after the HPV self-test is completed; (2) health center policies in place for follow-up care, regardless of the HPV self-test results; and (3) an educational component about the process of self-testing for the health-care providers and staff working at the health centers.…”

Are Health Care Professionals Prepared to Implement Human Papillomavirus Testing? A Review of Psychosocial Determinants of Human Papillomavirus Test Acceptability in Primary Cervical Cancer Screening

“…In Figure 1 we present the study selection diagram. In total, we retained 32 studies, four used qualitative (23)(24)(25)(26) and 28 used quantitative methodology (2,(16)(17)(18)(19)(20) . Included studies covered HCPs opinions from five continents: Europe (i.e., UK (47) , Germany (38) and Italy (39) ), North America (i.e., Canada (24,26,35) and the US (2, 16-20, 23, 29-31, 34, 36, 40-44, 46) ), Africa (i.e., Cameroon (28) and Nigeria (25) ), Asia (i.e., China (27) , Jordan (45) ,South Korea (33) and Thailand (37) ) and Oceania (i.e., Australia (32) ).…”

“…For women, the annual Pap screening could represent a culturally-embedded and difficult to dismantle expectation while for physicians it could be associated with economic incentives for continuing annual gynecologic follow-ups. This conclusion is further explained in that HCPs (notably, OB/GYNs) are worried that longer screening intervals would put patients at increased risk for cancer (with potential risk of HCP liability), would then result in higher rates of pre-cancer (18) and/or would negatively influence adherence to other annual examinations (e.g., pelvic examination) or screening tests (17,20) .…”

“…providers who recommended a three year interval after a normal co-test, reported more often that extending routine screening to three years would be good (80%), easy (67%) and beneficial (68%) compared to providers who recommended annual screening after a normal co-test (p < .05) (18) . Roland et al (2013) found that after normal co-test results, ~24% of HCPs perceived extending the screening interval in women ≥30 years as being harmful, difficult or bad (20) .…”

“…In the context of continuous change in primary cervical cancer screening recommendations (for both cytology and HPV testing) related to women's age of screening initiation, age-specific screening intervals and screening discontinuation, research indicates that less than 20% of healthcare providers (HCPs i.e., family practitioners (FPs), internal medicine specialists (IMs), obstetrics-gynecologists (OB/GYNs), nurse practitioners (NPs), physician assistants (PAs))in the US follow all age-related guideline recommendations released in 2009 or in 2012 by the American College of Obstetricians and Gynecologists (ACOG), American Cancer Society (ACS), and the United States Preventive Services Task Force (USPSTF) (16,17) . Poor practice implementation of HPV testing guidelines have been driven by HCPs' worry that increasing screening intervals with the HPV test would put women at increased risk of pre-cancer and cancer (18) and perception that the HPV test alone is less effective than cytology (Pap) in detecting pre-cancerous lesions (19) . HCPs are concerned that gynecologic health issues other than cervical cancer prevention could be missed if yearly examinations are not performed.…”