1
|
Schrier E, Holt HK, Kuppermann M, Sawaya GF. Changing Preferences for a Cervical Cancer Screening Strategy: Moving Away from Annual Testing. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2022; 3:709-717. [PMID: 36147829 PMCID: PMC9436266 DOI: 10.1089/whr.2022.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 11/12/2022]
Abstract
Background While annual cytology has not been recommended for many years, it remains many patients' preferred screening strategy for cervical cancer. Patient education and provider recommendations have been found effective in aligning professional society guidelines with patient preferences. We assessed whether an educational video with value elicitation exercises (utility assessments) changed screening strategy preferences among patients who had an initial preference for annual screening. Materials and Methods We conducted an interventional study of English- or Spanish-speaking women 21-65 years of age, recruited from two women's health clinics in San Francisco, California (n = 262). Participants were asked about their preferred method of screening before viewing a 7-minute educational video and using a computerized tool that elicited values for 23 different health states related to cervical cancer screening. Directly afterward, they were again asked about their preferred screening strategy. Multivariable regression analysis was utilized to identify independent predictors of changing preferences. Results Of 246 enrollees, 62.6% (154/246) had an initial preference for annual cytology; after viewing the video and completing the values elicitation exercises, about half (72/154, 47%) preferred a strategy other than annual screening. Having attended college and being screened every 3 to 5 years in the recent past were independent predictors of changing preferences away from annual screening. In sensitivity analyses, 53.2% of average-risk participants changed preferences away from annual cytology (p < 0.01). Conclusions Viewing an educational video and conducting a series of value elicitation exercises were associated with a substantially decreased likelihood of preferring annual screening. These findings underscore the importance of patient-centered education to help support informed patient preferences.
Collapse
Affiliation(s)
- Elizabeth Schrier
- School of Medicine, University of California, San Francisco, San Francisco, California, USA.,Address correspondence to: Elizabeth Schrier, BA, School of Medicine, University of California, San Francisco, San Francisco, 533 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Hunter K. Holt
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA.,Department of Family and Community Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Miriam Kuppermann
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - George F. Sawaya
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA.,Center for Healthcare Value, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
2
|
Li T, Yoon J, Luck J, Bui LN, Harvey M. The Impact of Continuity of Care on Cervical Cancer Screening: How Visit Pattern Affects Guideline Concordance. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:30-36. [PMID: 32542438 DOI: 10.1007/s13187-020-01777-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Cervical cancer can be prevented and highly curable if detected early. Current guidelines recommend women to receive cervical cancer screening starting at age 21. Our study aims to investigate how improving continuity of care (COC) may influence guideline concordance of cervical cancer screening. Using the eligibility and claims data, we created a person-month panel data set for women who were enrolled in Oregon Medicaid for at least 80% of the period from 2008 to 2015. We then selected our study cohort following the cervical cancer screening guidelines. Our dependent variable is whether a woman received cervical cancer screening concordant with guidelines in a given month, when she did not receive Pap test in the past 36 months and did not receive co-testing of HPV test plus Pap test in the past 60 months. We used both population-averaged logit model and conditional fixed-effect logit model to estimate the association between the guideline concordance and the COC index, after controlling for high risk, pregnancy, age, race, and ethnicity. A total of 466,526 person-month observations were included in our main models. A 0.1 unit increase of the COC score was significantly associated with a decrease in the odds of receiving guideline-concordant cervical cancer screening (population-averaged logit model: OR = 0.988, p < .001; conditional fixed-effect logit model: OR = 0.966, p < .001). Our findings remain robust to a series of sensitivity analyses. A better COC may not be necessarily beneficial to improving cervical cancer prevention. Educations for both physicians and patients should be supplemented to assure quality of preventive care.
Collapse
Affiliation(s)
- Tao Li
- Health Management and Policy Program, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, 458 Waldo Hall, 2250 SW Jefferson Way, Corvallis, OR, USA.
| | - Jangho Yoon
- Health Management and Policy Program, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, 458 Waldo Hall, 2250 SW Jefferson Way, Corvallis, OR, USA
| | - Jeff Luck
- Health Management and Policy Program, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, 458 Waldo Hall, 2250 SW Jefferson Way, Corvallis, OR, USA
| | - Linh N Bui
- Health Management and Policy Program, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, 458 Waldo Hall, 2250 SW Jefferson Way, Corvallis, OR, USA
- School of Pubic Health, University of California, Berkeley & Sutter Health Center for Health Systems Research, Berkeley, CA, USA
| | - Marie Harvey
- Health Management and Policy Program, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, 458 Waldo Hall, 2250 SW Jefferson Way, Corvallis, OR, USA
| |
Collapse
|
3
|
Castle PE, Kinney WK, Chen L, Kim JJ, Jenison S, Rossi G, Kang H, Cuzick J, Wheeler CM. Adherence to National Guidelines on Cervical Screening: A Population-Based Evaluation from a Statewide Registry. J Natl Cancer Inst 2021; 114:djab173. [PMID: 34463763 PMCID: PMC9002271 DOI: 10.1093/jnci/djab173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 04/05/2021] [Accepted: 08/25/2021] [Indexed: 12/04/2022] Open
Abstract
In 2012, national recommendations for cervical-cancer screening of women aged 30-64 years were quinquennial human papillomavirus and cytology co-testing or triennial cytology. Data from a state-wide surveillance program in New Mexico demonstrated 65.2% (95% confidence interval [95%CI]= 64.6%% to 65.7%) of women screened in 2019 had negative co-test within the last 3 years. Percentages of women screened in 2013, 2016, and 2019 with a prior negative co-test more than 5 and up to 7 years ago were 2.6% (95% CI = 2.2% to 2.9%), 2.1% (95% CI = 1.9% to 2.2%), and 6.5% (95% CI = 6.2% to 6.8%), respectively (2-sided P trend<.001). Percentages of women screened in 2013, 2016, and 2019 with a prior negative cytology more than 5 and up to 7 years ago were 3.8% (95% CI = 3.7% to 3.9%), 9.0% (95% CI = 8.7% to 9.3%), and 14.9% (95% CI = 14.4% to 15.4%), respectively (2-sided P trend<.001). Thus, in 2019, only 12.7% (95% CI = 12.4% to 13.1%) of the 30,215 women aged 30-64 years underwent co-testing and 27.7% (95% CI = 27.1% to 28.3%) of the 18,733 underwent cytology at the recommended interval. The observed under- and over-screening could result in increases in cervical-cancer incidence and harms and costs, respectively.
Collapse
Affiliation(s)
- Philip E Castle
- Albert Einstein College of Medicine, Bronx, NY, USA
- Division of Cancer Prevention and Division of Cancer Epidemiology and Genetics, National Institutes of Health, National Cancer Institute, Rockville, MD, USA
- National Institutes of Health, National Cancer Institute, Division of Cancer Prevention and Division of Cancer Epidemiology and Genetics, Rockville, MD, USA
| | | | - Lu Chen
- Comprehensive Cancer Center, Biostatistics Shared Resource, University of New Mexico, Albuquerque, NM, USA
| | - Jane J Kim
- Harvard T.H. Chan, School of Public Health, Boston, MA, USA
| | - Steven Jenison
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | | | - Huining Kang
- Comprehensive Cancer Center, Biostatistics Shared Resource, University of New Mexico, Albuquerque, NM, USA
| | - Jack Cuzick
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Cosette M Wheeler
- Comprehensive Cancer Center, Center for HPV Prevention, University of New Mexico, Albuquerque, USA
| | | |
Collapse
|
4
|
Dodd RH, Obermair HM, McCaffery KJ. Implementing changes to cervical screening: A qualitative study with health professionals. Aust N Z J Obstet Gynaecol 2020; 60:776-783. [PMID: 32510586 DOI: 10.1111/ajo.13200] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 05/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Profound changes were made to the Australian National Cervical Screening Program in December 2017, which included a reduction in the frequency of screening and a new cervical screening test. AIM To explore the attitudes and experiences of health professionals practising in Australia since implementation of these changes. MATERIALS AND METHODS Thirty-one semi-structured interviews were conducted with general practitioners, obstetricians and gynaecologists, pathologists and nurses involved in cervical screening Australia-wide. Data were analysed using Framework Analysis. RESULTS Overall, health professionals had positive attitudes toward the changes but described many challenges associated with their implementation. Participants discussed practical system challenges, communication and education, finding ways around the guidelines and other perceived 'collateral'. Practical system challenges included increased colposcopy referrals, limited access to the National Cancer Screening Register, a complex primary screening approach, and issues with self-collection. In terms of communication and education, limited public education was recognised, in addition to challenges with particular age groups of women. Finding ways around the guidelines were described, for example over-referring women for co-testing by stating symptoms, which could lead to overtreatment. Other perceived collateral were demonstrated through reduced opportunistic screening opportunities due to less frequent primary care presentations, and concern over the potential for further underscreening in already under-screened populations. CONCLUSIONS These findings provide insight into the challenges health professionals face with renewing programs, in terms of practical issues and unexpected downstream effects which need to be addressed to ensure future implementation of the program is streamlined.
Collapse
Affiliation(s)
- Rachael H Dodd
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Helena M Obermair
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Obstetrics & Gynaecology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Kirsten J McCaffery
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
5
|
Tatar O, Wade K, McBride E, Thompson E, Head KJ, Perez S, Shapiro GK, Waller J, Zimet G, Rosberger Z. 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. J Womens Health (Larchmt) 2020; 29:390-405. [DOI: 10.1089/jwh.2019.7678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Ovidiu Tatar
- Research Center-Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Kristina Wade
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Emily McBride
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Erika Thompson
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas
| | - Katharine J. Head
- Department of Communication Studies, IU School of Liberal Arts at IUPUI, Indianapolis, Indiana
| | | | - Gilla K. Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - Jo Waller
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Gregory Zimet
- Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Psychology, Psychiatry and Oncology, McGill University, Montreal, Canada
| |
Collapse
|
6
|
Caporossi A, Olicard C, Seigneurin A, Garnier A. [Interval between two smear tests for cervical cancer screening and characteristics of women with a short interval: Study in the department of Isère]. Rev Epidemiol Sante Publique 2019; 67:143-147. [PMID: 30981595 DOI: 10.1016/j.respe.2019.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 02/13/2019] [Accepted: 02/15/2019] [Indexed: 12/24/2022] Open
Abstract
AIMS In France, guidelines for cervical cancer screening recommend that women between the ages of 25-65 have a smear test performed once every three years. However, some women are screened significantly more frequently. In this study, we used a data-driven approach as opposed to a traditional hypothesis-driven approach to characterise the population of women who are screened more frequently than advised. METHODS Data came from an organised cervical cancer screening programme of a French department in the Alps (Isère). We retrospectively selected women aged between 25 to 65 years old who had at least two smear tests during the follow up period (2011-2015). We used a data-driven clustering approach to compare the population of over-screened women with other populations. We then performed a descriptive analysis of the over-screened population using univariate (Chi2 test) and multivariate (logistic regression) methods. RESULTS A total of 10,000 patients were randomly chosen from a population of 54,073. In our univariate analysis, women in the over-screened population were significantly younger, participated less in organised screening, were more likely to be followed by a gynaecologist and had more smear test results showing inflammation than the other populations. Patient location (urban v.s. rural area) was not significant for this population. The multivariate analysis confirmed these results. CONCLUSION This data-driven approach based on an unsupervised learning method enables us to more accurately characterise the over-screened population. These data invite to improve communication with the youngest women and the gynecologists to recall the benefit of an interval between two normal smears complying with the recommendations. This approach could help to improve the prevention and have a real impact on this Public Health issue.
Collapse
Affiliation(s)
- A Caporossi
- Pôle santé publique, département de méthodologie de l'information de santé, CHU de Grenoble-Alpes, 38000 Grenoble, France.
| | - C Olicard
- Office de lutte contre le cancer en Isère, 38240 Meylan, France
| | - A Seigneurin
- Pôle santé publique, service de qualitique et d'évaluation médicale, CHU de Grenoble-Alpes, 38000 Grenoble, France
| | - A Garnier
- Office de lutte contre le cancer en Isère, 38240 Meylan, France
| |
Collapse
|
7
|
Luque JS, Tarasenko YN, Chen C. Correlates of Cervical Cancer Screening Adherence Among Women in the U.S.: Findings from HINTS 2013-2014. J Prim Prev 2018; 39:329-344. [PMID: 29876723 PMCID: PMC10878428 DOI: 10.1007/s10935-018-0513-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Following the latest update of cervical cancer screening guidelines in 2012, we estimate the prevalence of guideline adherent cervical cancer screening and examine its associated factors among a nationally representative sample of US women aged 21-65 years. Our study was based on cross-sectional data from Cycles 3 (2013) and 4 (2014) of the Health Information National Trends Survey. The final analytic sample consisted of 2822 women. Guideline adherent cervical cancer screening was defined as having a Pap test within the last 3 years. Correlates of guideline adherent cervical cancer screening included socio-demographic and health-related characteristics and HPV/cervical cancer-related beliefs and knowledge items. Multivariable logistic regression analyses were used to estimate prevalence of guideline adherent screening. An estimated 81.3% of women aged 21-65 years reported being screened for cervical cancer within the last 3 years. Controlling for sociodemographic and health-related characteristics and survey year, women aged 46-65 years were less likely to be guideline adherent than those aged 21-30 years (aPR = 0.89; 95% CI 0.82-0.97). The adjusted prevalence of adherence was significantly higher among married/partnered than among not married women (aPR = 1.13; 95% CI 1.05-1.22), and those with one to three medical visits (aPR = 1.30; 95% CI 1.14-1.48), and four or more visits in the past year (aPR = 1.26; 95% CI 1.09-1.45) compared to those with no medical visits. Differences in unadjusted prevalence of guideline adherent screening depending on women's beliefs and knowledge about HPV and cervical cancer were not significant in adjusted analyses. Lack of interaction with a healthcare provider, being not married/partnered and increasing age continue to be risk factors of foregoing guideline adherent cervical cancer screening.
Collapse
Affiliation(s)
- John S Luque
- Institute of Public Health, Florida A&M University, 1515 South MLK Blvd., Ste. 207B, Tallahassee, FL, 32307, USA.
| | - Yelena N Tarasenko
- Department of Health Policy and Management, Georgia Southern University, Statesboro, GA, USA
- Department of Epidemiology, Georgia Southern University, Statesboro, GA, USA
| | - Chen Chen
- College of Nursing and Health Professions, University of Southern Indiana, Evansville, IN, USA
| |
Collapse
|
8
|
Pratte MA, Griffin A, Ogazi C, Yurasevecz S, Blanks CA, McCooey L, Kaufman JS. Racial/Ethnic Disparities in Cervical Cancer Screening Services Among Contractors of the Connecticut Breast and Cervical Cancer Early Detection Program. Health Equity 2018; 2:30-36. [PMID: 29696243 PMCID: PMC5909280 DOI: 10.1089/heq.2017.0038] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Racial/ethnic minority women are at increased risk for cervical cancer. The objective of this study is to use performance management data from the Connecticut Breast and Cervical Cancer Early Detection Program (CBCCEDP) to determine whether race/ethnicity disparities exist in human papillomavirus (HPV) co-testing uptake across CBCCEDP contractors. Methods: Secondary analysis of Connecticut's Minimum Data Elements data for 2013–2015 among 10 contractors participating in the CBCCEDP. Participants included women aged 30–64 years and eligible to receive routine cervical cancer screening services through the CBCCEDP (n=5,262). HPV co-testing uptake was compared across contractors and race/ethnicity groups within each contractor using chi-square and Fisher's exact tests as appropriate. Results: Overall, 62.9% of women received HPV co-testing services. Significant differences in co-testing rates were detected between racial/ethnic groups when data were examined across all contractors (p<0.001). Black women were least likely to receive co-testing (49.1%), while Hispanic women were most likely to receive co-testing (68.2%). When data were examined at the individual contractor level, significant differences between racial/ethnic groups were observed in 50% of the contractors. Conclusions: This study identified racial/ethnic disparities in uptake of HPV co-testing both overall and within individual contractors involved in the CBCCEDP. These findings will be used to guide program improvement with the goal of increasing quality and consistency of care for all women seeking screening services.
Collapse
Affiliation(s)
- Morgan A Pratte
- Department of Family Medicine, SUNY Upstate Medical University, Syracuse, New York
| | - Amy Griffin
- Program and Service System Evaluation, The Consultation Center, New Haven, Connecticut.,Department of Psychiatry, Yale University, New Haven, Connecticut
| | - Chioma Ogazi
- Comprehensive Cancer Program, Connecticut Department of Public Health, Hartford, Connecticut
| | - Susan Yurasevecz
- Comprehensive Cancer Program, Connecticut Department of Public Health, Hartford, Connecticut
| | - Carol A Blanks
- Comprehensive Cancer Program, Connecticut Department of Public Health, Hartford, Connecticut
| | - Lisa McCooey
- Comprehensive Cancer Program, Connecticut Department of Public Health, Hartford, Connecticut
| | - Joy S Kaufman
- Program and Service System Evaluation, The Consultation Center, New Haven, Connecticut.,Department of Psychiatry, Yale University, New Haven, Connecticut
| |
Collapse
|
9
|
Hallett LD, Gerber MR. Human Papillomavirus Testing by Veterans Administration Women's Health Providers: Are They Adhering to Guidelines? J Womens Health (Larchmt) 2017; 27:179-182. [PMID: 28885082 DOI: 10.1089/jwh.2016.6141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Evidence-based guidelines have been created by professional societies, including the United States Preventive Services Task Force (USPSTF) and American Society for Colposcopy and Cervical Pathology (ASCCP), for use of human papillomavirus (HPV) cotesting in cervical cancer screening. We investigated whether Veterans Health Administration (VA) providers at one VA medical center follow these guidelines. MATERIALS AND METHODS Retrospective chart review of women aged 21-65 who had an HPV test ordered with pap testing in fiscal year 2014 at one Veterans Administration (VA) medical center to evaluate concordance of HPV ordering with screening (USPSTF) and management (ASCCP) guidelines. We collected data on patient characteristics and gynecologic history and documented the reason, if given, for HPV testing. RESULTS Of the 210 eligible HPV tests evaluated, 142 tests (68%) were determined to be guideline discordant. Of the 142 guideline-discordant tests, 90 had no documented reason for HPV testing in the chart. Site of care was not significant. CONCLUSIONS This study demonstrates potential overuse of HPV testing among women's health providers at one VA medical center. This may indicate that VA providers lack an understanding of HPV cotesting guidelines. Further studies are needed to characterize VA provider adherence to HPV testing guidelines nationally. Implementation of educational interventions and decision aids may improve VA providers' adherence to guidelines.
Collapse
Affiliation(s)
- Laura D Hallett
- 1 Department of Medicine, UMass Memorial Health Care , Worcester, Massachusetts
| | - Megan R Gerber
- 2 VA Boston Healthcare System , Jamaica Plain, Massachusetts.,3 Division of General Internal Medicine, Department of Medicine, Boston University School of Medicine , Boston, Massachusetts
| |
Collapse
|
10
|
Castle PE. When Less is More. J Natl Cancer Inst 2017; 109:djw240. [DOI: 10.1093/jnci/djw240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 09/22/2016] [Indexed: 11/12/2022] Open
|