1
|
Schuttner L, Haraldsson B, Maynard C, Helfrich CD, Reddy A, Parikh T, Nelson KM, Wong E. Factors Associated With Low-Value Cancer Screenings in the Veterans Health Administration. JAMA Netw Open 2021; 4:e2130581. [PMID: 34677595 PMCID: PMC8536952 DOI: 10.1001/jamanetworkopen.2021.30581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
IMPORTANCE Most clinical practice guidelines recommend stopping cancer screenings when risks exceed benefits, yet low-value screenings persist. The Veterans Health Administration focuses on improving the value and quality of care, using a patient-centered medical home model that may affect cancer screening behavior. OBJECTIVE To understand rates and factors associated with outpatient low-value cancer screenings. DESIGN, SETTING, AND PARTICIPANTS This cohort study assessed the receipt of low-value cancer screening and associated factors among 5 993 010 veterans. Four measures of low-value cancer screening defined by validated recommendations of practices to avoid were constructed using administrative data. Patients with cancer screenings in 2017 at Veterans Health Administration primary care clinics were included. Excluded patients had recent symptoms or historic high-risk diagnoses that may affect test appropriateness (eg, melena preceding colonoscopy). Data were analyzed from December 23, 2019, to June 21, 2021. EXPOSURES Receipt of cancer screening test. MAIN OUTCOMES AND MEASURES Low-value screenings were defined as occurring for average-risk patients outside of guideline-recommended ages or if the 1-year mortality risk estimated using a previously validated score was at least 50%. Factors evaluated in multivariable regression models included patient, clinician, and clinic characteristics and patient-centered medical home domain performance for team-based care, access, and continuity previously developed from administrative and survey data. RESULTS Of 5 993 010 veterans (mean [SD] age, 63.1 [16.8] years; 5 496 976 men [91.7%]; 1 027 836 non-Hispanic Black [17.2%] and 4 539 341 non-Hispanic White [75.7%] race and ethnicity) enrolled in primary care, 903 612 of 4 647 479 men of average risk (19.4%) underwent prostate cancer screening; 299 765 of 5 770 622 patients of average risk (5.2%) underwent colorectal cancer screening; 21 930 of 469 045 women of average risk (4.7%) underwent breast cancer screening; and 65 511 of 458 086 women of average risk (14.3%) underwent cervical cancer screening. Of patients screened, low-value testing was rare for 3 cancers, with receipt of a low-value test in 633 of 21 930 of women screened for breast cancer (2.9%), 630 of 65 511 of women screened for cervical cancer (1.0%), and 6790 of 299 765 of patients screened for colorectal cancer (2.3%). However, 350 705 of 4 647 479 of screened men (7.5%) received a low-value prostate cancer test. Patient race and ethnicity, sociodemographic factors, and illness burden were significantly associated with likelihood of receipt of low-value tests among screened patients. No single patient-, clinician-, or clinic-level factor explained the receipt of a low-value test across cancer screening cohorts. CONCLUSIONS AND RELEVANCE This large cohort study found that low-value breast, cervical, and colorectal cancer screenings were rare in the Veterans Health Administration, but more than one-third of patients screened for prostate cancer were tested outside of clinical practice guidelines. Guideline-discordant care has quality implications and is not consistently explained by associated multilevel factors.
Collapse
Affiliation(s)
- Linnaea Schuttner
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington
- Department of Medicine, University of Washington, Seattle
| | | | - Charles Maynard
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington
- Department of Health Systems and Population Health, University of Washington, Seattle
| | - Christian D. Helfrich
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington
- Department of Health Systems and Population Health, University of Washington, Seattle
| | - Ashok Reddy
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington
- Department of Medicine, University of Washington, Seattle
| | - Toral Parikh
- Department of Medicine, University of Washington, Seattle
- Geriatrics and Extended Care, VA Puget Sound Healthcare System
| | - Karin M. Nelson
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington
- Department of Medicine, University of Washington, Seattle
| | - Edwin Wong
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington
- Department of Health Systems and Population Health, University of Washington, Seattle
| |
Collapse
|
2
|
Pruitt SL, Werner CL, Borton EK, Sanders JM, Balasubramanian BA, Barnes A, Betts AC, Skinner CS, Tiro JA. Cervical Cancer Burden and Opportunities for Prevention in a Safety-Net Healthcare System. Cancer Epidemiol Biomarkers Prev 2018; 27:1398-1406. [PMID: 30185535 DOI: 10.1158/1055-9965.epi-17-0912] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/29/2018] [Accepted: 08/30/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The high prevalence of cervical cancer at safety-net health systems requires careful analysis to best inform prevention and quality improvement efforts. We characterized cervical cancer burden and identified opportunities for prevention in a U.S. safety-net system. METHODS We reviewed tumor registry and electronic health record (EHR) data of women with invasive cervical cancer with ages 18+, diagnosed between 2010 and 2015, in a large, integrated urban safety-net. We developed an algorithm to: (i) classify whether women had been engaged in care (≥1 clinical encounter between 6 months and 5 years before cancer diagnosis); and (ii) identify missed opportunities (no screening, no follow-up, failure of a test to detect cancer, and treatment failure) and associated factors among engaged patients. RESULTS Of 419 women with cervical cancer, more than half (58%) were stage 2B or higher at diagnosis and 40% were uninsured. Most (69%) had no prior healthcare system contact; 47% were diagnosed elsewhere. Among 122 engaged in care prior to diagnosis, failure to screen was most common (63%), followed by lack of follow-up (21%), and failure of test to detect cancer (16%). Tumor stage, patient characteristics, and healthcare utilization differed across groups. CONCLUSIONS Safety-net healthcare systems face a high cervical cancer burden, mainly from women with no prior contact with the system. To prevent or detect cancer early, community-based efforts should encourage uninsured women to use safety-nets for primary care and preventive services. IMPACT Among engaged patients, strategies to increase screening and follow-up of abnormal screening tests could prevent over 80% of cervical cancer cases.
Collapse
Affiliation(s)
- Sandi L Pruitt
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas. .,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
| | - Claudia L Werner
- Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, Texas.,Parkland Health and Hospital System, Dallas, Texas
| | - Eric K Borton
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas
| | - Joanne M Sanders
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas
| | - Bijal A Balasubramanian
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas.,Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health in Dallas, Dallas, Texas
| | - Arti Barnes
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Andrea C Betts
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas.,Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health in Dallas, Dallas, Texas
| | - Celette Sugg Skinner
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas.,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
| | - Jasmin A Tiro
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas.,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
3
|
Sicsic J, Franc C. Obstacles to the uptake of breast, cervical, and colorectal cancer screenings: what remains to be achieved by French national programmes? BMC Health Serv Res 2014; 14:465. [PMID: 25282370 PMCID: PMC4282512 DOI: 10.1186/1472-6963-14-465] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 09/16/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In France, equality in access to screening has been one of the main thrusts of public policies implemented between 2009 and 2013 (the national cancer plan). Our aim in this study was to analyse the obstacles to and levers for breast, cervical, and colorectal cancer screening uptake and their trends over time. METHODS Based on representative data from the French Health Care and Health Insurance Survey (three independent, cross-sectional surveys: 2006, 2008, and 2010), multivariate logistic regressions were used to model the association between the nonuse of screening for the three cancers and various independent variables. Then, interactions with survey year dummies allowed the changes in the determinants of these cancer screenings over time to be estimated. RESULTS Whereas the incentives for screening were strengthened during the period considered, cervical and breast cancer screenings decreased, and colorectal cancer screenings increased sharply (from 18.2% (95% CI = [17.0-19.4]) in 2006 to 38.9% (95% CI = [37.4-40.5] in 2010. Under-users of the three cancer screenings were primarily unskilled workers (ORcervix = 1.64 [1.38-1.95]), individuals without complementary health insurance (ORbreast = 2.05 [1.68-2.51]), or individuals with free complementary health insurance who more rarely use outpatient care. Moreover, individuals reporting either risky behaviours, namely heavy smokers (ORcolorectal = 1.70) and high-risk drinkers (ORcervix = 1.42) or very safe behaviours, namely neither smoking nor drinking, underused screenings. Despite the implementation of national programmes for breast and colorectal cancer screenings, the disparities and inequalities in screening uptake did not decrease over the study period. CONCLUSIONS These results demonstrate the need for additional primary prevention efforts targeting the identified under-users by focusing on, for instance, individuals with a very healthy lifestyle. Health authorities could also intensify their efforts to promote increased access to screening for the most disadvantaged individuals.
Collapse
Affiliation(s)
- Jonathan Sicsic
- Cermes3, UMR8211, Inserm U988, Site CNRS, 7, rue Guy Moquet, 94801 Villejuif Cedex, France.
| | | |
Collapse
|
4
|
Carney PA, O'Malley J, Buckley DI, Mori M, Lieberman DA, Fagnan LJ, Wallace J, Liu B, Morris C. Influence of health insurance coverage on breast, cervical, and colorectal cancer screening in rural primary care settings. Cancer 2012; 118:6217-25. [PMID: 22648383 PMCID: PMC3864695 DOI: 10.1002/cncr.27635] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 01/20/2012] [Accepted: 03/06/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND The current study was performed to determine, in rural settings, the relation between the type and status of insurance coverage and being up-to-date for breast, cervical, and colorectal cancer screening. METHODS Four primary care practices in 2 rural Oregon communities participated. Medical chart reviews that were conducted between October 2008 and August 2009 assessed insurance coverage and up-to-date status for breast, cervical, and colorectal cancer screening. Inclusion criteria involved having at least 1 health care visit within the past 5 years and being aged ≥ 55 years. RESULTS The majority of patients were women aged 55 years to 70 years, employed or retired, and who had private health insurance and an average of 2.5 comorbid conditions. The overall percentage of eligible women who were up-to-date for cervical cancer screening was 30%; approximately 27% of women were up-to-date for clinical breast examination, 37% were up-to-date for mammography, and 19% were up-to-date for both mammography and clinical breast examination. Approximately 38% of men and 35% of women were up-to-date for colorectal cancer screening using any test at appropriate screening intervals. In general, having any insurance versus being uninsured was associated with undergoing cancer screening. For each type of screening, patients who had at least 1 health maintenance visit were significantly more likely to be up-to-date compared with those with no health maintenance visits. A significant interaction was found between having health maintenance visits, having any health insurance, and being up-to-date for cancer screening tests. CONCLUSIONS Overall, the percentage of patients who were up-to-date for any cancer screening, especially cervical cancer screening, was found to be very low in rural Oregon. Patients with some form of health insurance were more likely to have had a health maintenance visit within the previous 2 years and to be up-to-date for breast, cervical, and/or colorectal cancer screening.
Collapse
Affiliation(s)
- Patricia A Carney
- Department of Family Medicine, School of Medicine, Oregon Health and Science University, Portland, Oregon 97239-3098, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
5
|
McAlearney AS, Oliveri JM, Post DM, Song PH, Jacobs E, Waibel J, Harrop JP, Steinman K, Paskett ED. Trust and distrust among Appalachian women regarding cervical cancer screening: a qualitative study. PATIENT EDUCATION AND COUNSELING 2012; 86:120-6. [PMID: 21458195 PMCID: PMC3178720 DOI: 10.1016/j.pec.2011.02.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 02/04/2011] [Accepted: 02/23/2011] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To explore Appalachian women's perceptions of trust and distrust of healthcare providers and the medical care system as they relate to views about cervical cancer and screening. METHODS Thirty-six Ohio Appalachia female residents participated in community focus groups conducted by trained facilitators. Discussion topics included factors related to cervical cancer, and the issues of trust and distrust in medical care. The tape-recorded focus groups were transcribed and analyzed to identify salient themes. RESULTS Five themes emerged related to trust in healthcare. Patient-centered communication and encouragement from a healthcare provider led women to trust their physicians and the medical care system. In contrast, lack of patient-centered communication by providers and perceptions of poor quality of care led to distrust. Physician gender concordance also contributed to trust as women reported trust of female physicians and distrust of male physicians; trust in male physicians was reported to be increased by the presence of a female nurse. CONCLUSIONS Important factors associated with trust and distrust of providers and the medical care system may impact health-seeking behaviors among underserved women. PRACTICE IMPLICATIONS Opportunities to improve patient-centered communication around the issues of prevention and cervical cancer screening (such as providing patient-focused information about access to appropriate screening tests) could be used to improve patient care and build patients' trust.
Collapse
Affiliation(s)
- Ann Scheck McAlearney
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH 43210, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Shippee ND, Mullan RJ, Nabhan M, Kermott CA, Hagen PT, Rhodes DJ, Montori VM, Murad MH. Adherence to preventive recommendations: experience of a cohort presenting for executive health care. Popul Health Manag 2011; 15:65-70. [PMID: 22092188 DOI: 10.1089/pop.2011.0029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Adherence to recommended preventive services and immunizations in adults is suboptimal and often associated with socioeconomic status, race, and access to care. The aim of this study is to evaluate adherence in a cohort without these barriers to ascertain realistically optimal adherence rates and to examine remaining barriers among relatively advantaged individuals. Specifically, it employed a sample of 6889 patients presenting for executive health care from 2005 to 2009. Adherence varied across colorectal cancer screening (79%), mammography (89%), cervical cancer screening (91%), tetanus immunization (82%), and pneumococcal vaccination (62%). Multivariate logistic regressions revealed that age, education, alcohol use concerns, and being married were positively associated with adherence to certain services. Individuals without the usual barriers to care have variable, less-than-ideal rates of adherence to preventive services, which correlate with some health behaviors and demographics. Understanding the predictors of adherence may inform quality improvement processes aimed at optimizing disease prevention.
Collapse
Affiliation(s)
- Nathan D Shippee
- Division of Health Care Policy and Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | | | | | | | | | | | | | | |
Collapse
|
7
|
Decker K, Demers A, Chateau D, Musto G, Nugent Z, Lotocki R, Harrison M. Papanicolaou test utilization and frequency of screening opportunities among women diagnosed with cervical cancer. OPEN MEDICINE : A PEER-REVIEWED, INDEPENDENT, OPEN-ACCESS JOURNAL 2009; 3:e140-7. [PMID: 21603052 PMCID: PMC3090124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Revised: 06/15/2007] [Accepted: 06/26/2008] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although the importance of Papanicolaou (Pap) smear test screening in reducing the incidence of cervical cancer is well established, in 1994-95 one in 4 women in Manitoba aged 18 to 69 years reported never having had a Pap test or not having had a Pap test in the last 3 years. The objectives of this study were to examine the screening history of women in Manitoba diagnosed with invasive cervical cancer and to explore whether opportunities for screening were missed. METHODS In this case-control study women aged 18 years and older who resided in Manitoba and were diagnosed with invasive cervical cancer between 1989 and 2001 were each matched by age and area of residence to 5 controls, (N = 4009). Conditional logistic regression analyses were used to examine the association between Pap test utilization and the likelihood of diagnosis with invasive cervical cancer. Generalized linear models using the negative binomial distribution were used to assess the association between cancer status and rates of prior Pap testing and of opportunities to be screened. Logistic generalized estimating equation models were used for the analysis of physician characteristics. RESULTS Forty-six percent of women in Manitoba diagnosed with invasive cervical cancer and 67% of the control group had received a Pap test in the 5 years before the case's diagnosis. After adjustment for age, income and residence, the rate of Pap testing was significantly higher in the control group (rate ratio [RR] = 1.57, 95% confidence interval [CI] 1.44-1.73). Conversely, when cervical cancer was the outcome, women who had not had Pap tests were more likely to be diagnosed with invasive cervical cancer (odds ratio [OR] = 2.77, 95% CI 2.30-3.30) than women who did have a Pap test. Although women diagnosed with invasive cervical cancer had fewer Pap tests, they had had as many opportunities to be screened as controls (RR = 1.04, 95% CI 0.96-1.12). Compared with urban family physicians, rural family physicians were less likely to provide Pap tests (OR = 0.68, 95% CI 0.58-0.80) and specialists were more likely to provide Pap tests (OR = 1.70, 95% CI 1.30-2.22). CONCLUSIONS Women who were diagnosed with invasive cervical cancer in the province of Manitoba, Canada, had fewer Pap tests but the same frequency of opportunities to be screened as matched controls. These results reinforce the need to educate women about cervical cancer screening and the importance of receiving Pap tests.
Collapse
|
8
|
Insinga RP, Dasbach EJ, Elbasha EH. Epidemiologic natural history and clinical management of Human Papillomavirus (HPV) Disease: a critical and systematic review of the literature in the development of an HPV dynamic transmission model. BMC Infect Dis 2009; 9:119. [PMID: 19640281 PMCID: PMC2728100 DOI: 10.1186/1471-2334-9-119] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Accepted: 07/29/2009] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Natural history models of human papillomavirus (HPV) infection and disease have been used in a number of policy evaluations of technologies to prevent and screen for HPV disease (e.g., cervical cancer, anogenital warts), sometimes with wide variation in values for epidemiologic and clinical inputs. The objectives of this study are to: (1) Provide an updated critical and systematic review of the evidence base to support epidemiologic and clinical modeling of key HPV disease-related parameters in the context of an HPV multi-type disease transmission model which we have applied within a U.S. population context; (2) Identify areas where additional studies are particularly needed. METHODS Consistent with our and other prior HPV natural history models, the literature review was confined to cervical disease and genital warts. Between October 2005 and January 2006, data were gathered from the published English language medical literature through a search of the PubMed database and references were examined from prior HPV natural history models and review papers. Study design and data quality from individual studies were compared and analyses meeting pre-defined criteria were selected. RESULTS Published data meeting review eligibility criteria were most plentiful for natural history parameters relating to the progression and regression of cervical intraepithelial neoplasia (CIN) without HPV typing, and data concerning the natural history of HPV disease due to specific HPV types were often lacking. Epidemiologic evidence to support age-dependency in the risk of progression and regression of HPV disease was found to be weak, and an alternative hypothesis concerning the time-dependence of transition rates is explored. No data were found on the duration of immunity following HPV infection. In the area of clinical management, data were observed to be lacking on the proportion of clinically manifest anogenital warts that are treated and the proportion of cervical cancer cases that become symptomatic by stage. CONCLUSION Knowledge of the natural history of HPV disease has been considerably enhanced over the past two decades, through the publication of an increasing number of relevant studies. However, considerable opportunity remains for advancing our understanding of HPV natural history and the quality of associated models, particularly with respect to examining HPV age- and type-specific outcomes, and acquired immunity following infection.
Collapse
Affiliation(s)
- Ralph P Insinga
- Department of Health Economic Statistics, Merck Research Laboratories, North Wales, PA, USA
| | - Erik J Dasbach
- Department of Health Economic Statistics, Merck Research Laboratories, North Wales, PA, USA
| | - Elamin H Elbasha
- Department of Health Economic Statistics, Merck Research Laboratories, North Wales, PA, USA
| |
Collapse
|
9
|
Insinga RP, Dasbach EJ, Elbasha EH. Structural differences among cost-effectiveness models of human papillomavirus vaccines. Expert Rev Vaccines 2008; 7:895-913. [PMID: 18767941 DOI: 10.1586/14760584.7.7.895] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this article we compare previously published cost-effectiveness studies of human papillomavirus (HPV) vaccines along a defined subset of key model structural assumptions relating to HPV infection and disease, cervical cancer screening and HPV vaccination. For each structural aspect examined, we summarize assumptions from each study, provide a critical review and discuss the impact upon results. Considerable variation was observed across HPV vaccine cost-effectiveness models in a number of influential assumptions. Holding constant factors for which current data are lacking, the combined impact of assumptions made for the remaining parameters examined would appear to tend toward underestimation of the cost-effectiveness of HPV vaccination within existing studies. However, uncertainty concerning parameters, such as the duration of vaccine protection and acquired immunity following HPV infection, and the relationship between age and HPV virulence, complicates precise estimation of the cost-effectiveness of HPV vaccination and rigorous evaluation of the validity of existing modeling results.
Collapse
Affiliation(s)
- Ralph P Insinga
- Department of Health Economic Statistics, Merck Research Laboratories, North Wales, PA 19454-1099, USA.
| | | | | |
Collapse
|
10
|
Buetow S, Janes R, Steed R, Ihimaera L, Elley CR. Why don't some women return for cervical smears? A hermeneutic phenomenological investigation. Health Care Women Int 2008; 28:843-52. [PMID: 17907011 DOI: 10.1080/07399330701563251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
To enhance understanding of how having a cervical smear can lead some women not to keep up-to-date with this test, a hermeneutic (interpretative) phenomenological study was undertaken. Participants were six purposively selected New Zealand women -- predominantly Māori -- at least 6 months overdue for a follow-up cervical screen in the previous 6 years. Each woman gave an in-depth interview. Transcribed and analyzed via a general inductive approach, the interviews suggested that the smears can violate women's positive aloneness with their bodies, and magnify aloneness as a negative state. Overdueness for the test avoids these effects. To minimize such effects, primary health care needs to acknowledge and address these issues, for example by providing an opportunity to connect the aloneness to trusted others.
Collapse
Affiliation(s)
- Stephen Buetow
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand.
| | | | | | | | | |
Collapse
|
11
|
Akers AY, Newmann SJ, Smith JS. Factors underlying disparities in cervical cancer incidence, screening, and treatment in the United States. Curr Probl Cancer 2007; 31:157-81. [PMID: 17543946 DOI: 10.1016/j.currproblcancer.2007.01.001] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Aletha Y Akers
- Robert Wood Johnson Clinical Scholars Program, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | | |
Collapse
|
12
|
Spence AR, Goggin P, Franco EL. Process of care failures in invasive cervical cancer: systematic review and meta-analysis. Prev Med 2007; 45:93-106. [PMID: 17651792 DOI: 10.1016/j.ypmed.2007.06.007] [Citation(s) in RCA: 169] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Revised: 05/24/2007] [Accepted: 06/05/2007] [Indexed: 11/21/2022]
Abstract
OBJECTIVE As invasive cervical cancer is preventable when screening and treatment of pre-invasive lesions are timely and appropriate, several past studies attempted to enumerate the quality of preventive care invasive cervical cancer subjects received before diagnosis. Objectives of the present study were to review and to summarize the findings of these studies in a meta-analysis. METHOD Data from 42 studies were used to estimate DerSimonian and Laird random effects models for the various failures in care along the cancer care continuum. Analyses were also conducted within strata characterized by variables deemed to account for heterogeneity in meta-regression analyses. RESULTS Poor Pap screening frequency was the primary factor attributable to development of invasive cervical cancer. On average, 53.8% (95% confidence interval: 43.6-66.3) of invasive cervical cancer subjects had inadequate screening histories and 41.5% (95% confidence interval: 35.4-48.7) were never screened. There was significant temporal improvement in the proportion of women screened at least once over a lifetime but not in the proportion with overall deficient histories. An estimated 29.3% (95% confidence interval: 21.2-40.4) of failures to prevent invasive cervical cancer can be attributed to false-negative Pap smears and 11.9% (95% confidence interval: 9.0-15.6) to poor follow-up of abnormal results. CONCLUSION Appropriate assessment of the effect of combined failures in the process of care must be done in comprehensive audit studies.
Collapse
Affiliation(s)
- Andrea R Spence
- Department of Oncology and Epidemiology, McGill University, Montreal, Quebec, Canada
| | | | | |
Collapse
|
13
|
Insinga RP, Glass AG, Rush BB. Response to "Use of cervical cancer screening among insured women: the extent of missed opportunities" [Health Policy 73 (2005) 194-201]. Health Policy 2005; 77:245-6. [PMID: 16297495 DOI: 10.1016/j.healthpol.2005.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2005] [Accepted: 10/03/2005] [Indexed: 10/25/2022]
|