“They Should Be Asking Us”: A Qualitative Decisional Needs Assessment for Women Considering Cervical Cancer Screening

Abstract

In this study, we examine from multiple perspectives, women’s shared decision-making needs when considering cervical screening options: Pap testing, in-clinic human papillomavirus (HPV) testing, self-collected HPV testing, or no screening. The Ottawa Decision Support Framework guided the development of the interview schedule. We conducted semi-structured interviews with seven screen-eligible women and five health care professionals (three health care providers and two health system managers). Women did not perceive that cervical screening involves a “decision,” which limited their knowledge of options, risks, and benefits. Women and health professionals emphasized how a trusted primary care provider can support women making a choice among cervical screening modalities. Having all cervical screening options recommended and funded was perceived as an important step to facilitate shared decision making. Supporting women in making preference-based decisions in cervical cancer screening may increase screening among those who do not undergo screening regularly and decrease uptake in women who are over-screened.

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 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) ). Details of each included study can be found in Appendix A.…”

“…(42) . HCPs believe that providing positive HPV test results require appropriate communication strategies to alleviate women's stigma associated with an sexually transmitted infection (STI) diagnosis (26) .…”

Development and field testing of a tool to elicit women's preferences among cervical cancer screening modalities

“…“Cervical cancer screening—it's your choice” explicitly acknowledges that women face a decision to undergo cervical cancer screening, and if they choose to participate, they may choose different options because they value the risks and benefits differently. We found in a qualitative needs assessment that some women do not perceive that undergoing cervical cancer screening involves making a decision …”

“…It is unclear how women who are racialized, women who have lower levels of education, or women with lower health literacy would perceive the language, presentation, and content of this tool. Because racialized women and women with lower levels of education are less likely to participate in regular screening, and perhaps less likely to face a decision about cervical screening, the perceptions of these populations are important for equitable cervical screening. Because of the small, highly selected sample, a more robust study design, preferably using a probability sample, is required to yield more generalizable conclusions about the tool's ability to elicit informed, values‐based preferences.…”

“…We found in a qualitative needs assessment 51 that some women do not perceive that undergoing cervical cancer screening involves making a decision. 51 We have addressed this gap by developing a tool that promotes intentional contemplation to undergo cervical cancer screening while supporting an autonomous, person-centred approach to health care. This tool can be used in future research within cervical cancer screening programmes that are transitioning to an HPV-testing population screening approach.…”