Cervical cancer screening for hospital inpatients: report of an intervention study

Nurse practitioners and preventive screening in the hospital

The purpose of this study was to investigate a reminder to discuss cervical cancer screening with hospitalized females. A quasi-experimental design was used to compare the association of a reminder intervention for nurse practitioners with two outcomes: prevalence of cervical cancer screening as documented in patients' charts and patients' self-report of cervical cancer screening 4 months after discharge. Data were collected by chart review and phone survey. The sample consisted of nurse practitioners caring for eligible female patients at a university teaching hospital. Chi-square was used to test all research questions. The rate of documentation of cervical cancer screening increased from 2% to 69% after implementation of the reminder intervention. The reminder intervention did not impact patients actually receiving Pap smears after discharge. The significant increase in documentation of screening associated with the use of the single reminder in the patients' charts support the use of this low-cost intervention.

Improving cervical cancer screening in hospital settings

BACKGROUND

Identifying opportunities to offer cervical cancer screening to underscreened women is important for increasing early detection. Maryland law mandates offering Pap tests during hospital admissions. We examined organizational and physician attitudes and practices regarding inpatient screening, to identify mechanisms for increasing the law's effectiveness.

METHODS

We analyzed state admission data, a hospital administrators telephone survey, and a mailed survey of Maryland primary and specialty care physicians, to identify overall patterns and subgroup differences regarding screening.

RESULTS

Overall, we found significant concern regarding cancer, and evidence of policies and procedures for screening. However, most hospitals and providers offered screening without assessing clinical need or including persuasive recommendations. Providers with significantly less engagement in preventive assessment and screening included medical and surgical subspecialists and non-primary care providers. Providers to African-American and Medical Assistance women were also less likely to have knowledge, attitudes, and practices conducive to inpatient screening.

CONCLUSIONS

Adequate support and infrastructure for preventive screening exist within hospitals. Adding clinical assessment and persuasive education could in crease the impact of these mechanisms, and improve prevention among underscreened inpatient populations.

Evaluation of doctors' reminders in emergency departments to encourage cervical screening

OBJECTIVE

To evaluate opportunistic reminders in emergency departments (EDs) about cervical smears.

METHOD

Five EDs in Sydney in 1995-96 participated in a block-randomised control trial, whereby unscreened women at risk for cervical cancer who were seen as nonacute cases were allocated either to brief advice at the end of the ED consultation to return to their GP for a smear (intervention) or usual care (control). Blinded follow-up telephone interviews determined women's compliance four weeks later.

RESULTS

217 women at risk for cervical cancer presented, of whom 53 (23%) were overdue for a Pap smear (22 intervention group; 31 control group). At follow-up, no women in the intervention group had had a smear, although 3 (10%) in the control group had (p = 0.25).

CONCLUSIONS

Opportunities in EDs in NSW for opportunistic reminders are infrequent and, even if taken, are unlikely to encourage screening over and above usual care.

IMPLICATIONS

General practice remains a more effective location for opportunistic recruitment, although interventions with hospitalised in-patients also show greater promise than reminders in EDs.

A review of cervical cancer screening intervention research: implications for public health programs and future research

In this paper we review the published literature with respect to cervical cancer screening intervention research. Mass media campaigns appear to work best in promoting cervical cancer screening when multiple media are used, when they promote specific screening programs that eliminate or reduce access barriers, or when they are used in combination with other strategies. Many positive examples of using outreach staff to promote cervical cancer screening, as well as using mobile examination rooms in the community, were found. Substantial evidence that letters mailed to patient populations are efficacious was found, especially in promoting interval screening; however, bulk mailings to nonpatient populations have generally not been successful. Both physician and patient prompts have shown promise as well as opportunistic screenings in both the outpatient and the inpatient settings. In addition, several strategies for reducing loss to follow-up among women with abnormal test results were identified, including telephone follow-up, educational mailouts, audiovisual programs, clinic-based educational presentations and workshops, transportation incentives, and economic vouchers. Of special note is the success of other countries in establishing centralized recall systems to promote interval screening for cervical cancer. Ultimately, such systems could replace the need for opportunistic screening in underserved populations and perhaps many community outreach efforts. It is argued that health departments represent a logical starting point for developing a network of recall systems in the United States for underserved women.