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Item type Presentation

Format Text-based Document

Title Patient Acceptance of Decreased Cervical CancerScreening Frequency in an Urban Practice

Authors Hudes-Lowder, Meredith; Collins, Elizabeth Cole

Downloaded 20-Jun-2018 07:04:36

Link to item http://hdl.handle.net/10755/621151

Patient Acceptance of Decreased Cervical

Cancer Screening Frequency

in an Urban Practice

Meredith Anne Hudes-Lowder, DNP, WHNP-BC

Elizabeth Cole Collins, PhD, WHNP-BC, IBCLC

AdvantageCare

PHYSICIANS

Background

History

o 1928 George Papanicolaou discovers malignant cervical cells can be

seen through a microscope

o 1943 First introduction of Pap Smear Test

o 1983-84 Human papillomavirus is discovered to cause cervical cancer

o 1988 The Bethesda System standardizes Pap test results

o 1999 DNA testing for HPV approved

o 2006 HPV vaccine approved; 2009 approved for boys

o 2012-13 ASCCP, ACOG & USPSTF support current guidelines for

cervical cancer screening

Background Summary

o Guidelines are designed to maximize benefits and limit potential harm

from over-screening

o Over two decades have passed since the first triennial frequency was

proposed

o Providers and women continue to view the increased interval with

resistance and suspicion

o NPWH (2015) conducted a survey of patients, nurse practitioners,

primary care physicians, and gynecologists• all had the same reluctance to embrace guideline changes

• all providers believed the interval would not be a positive contribution to

their patients’ health

• there is a lack of patient understanding regarding the purpose of cervical

cancer screening

o Most HPV infections are transitory and regress within 1-2 years, those

that do not regress may take years to undergo oncogenic changes

Purpose of the Study

o To examine women’s preferences for cervical cancer

screening frequency in a multiethnic urban medical

practice

Overview of the Literature

Risks of overtesting

o Unnecessary procedures

o Stigma of having sexually transmitted infection

o Cervical damage

Overview of the Literature

Concerns of providers

o Providers play a key role in dissemination of guidelines and

recommendations

o The majority of physicians do not adhere to the recommended

screening guidelines

o Reasons identified by physicians • fear of litigation in case of poor outcomes

• patient expectations

• assuage patient anxiety

• client retention

• guidelines frequently change

Overview of the Literature

Concerns of women

o Many studies concluded that women are reluctant to extend the

cervical cancer screening interval

o Reasons identified by women• anxiety regarding cervical cancer

• fear of a cervical cancer diagnosis

• expectation of annual testing

• low-income status predicted less acceptance

• they attributed reason for less frequent screening to insurance companies dictating their health

o Most women did not know the purpose of cervical cancer screening

o Education and age were not consistent predictors of acceptance

Methods

o Design• descriptive, cross-sectional design

o Setting• two private offices located in New York City

o Sample• convenience sample of women, N = 250

• inclusion criteria

• age 33-65

• exclusion criteria

• history of gynecologic cancer

• removal of cervix

• pregnancy

o Protection of Human Subjects

• Stony Brook University IRB approval

Methods

o Survey• self-administered

• adapted with permission from Silver et al. (2015)

o Survey questions• participants’ current cervical cancer screening frequency

• opinions about appropriate screening intervals

• perceived risk of a personal cervical cancer diagnosis

• concerns about a longer screening interval

o Analysis• descriptive statistics and bivariate analyses used to characterize

the sample and examine associations between variables

Description of the SampleN = 250

Age, years (mean = 44.1, SD = 8.4)

33-41 50.4%

42-51 28.4%

52-60 21.2%

Ethnicity

African American 39.2%

Hispanic 31.6%

Caucasian 22.0%

Other 7.2%

Marital Status

Single, never married 33.2%

Married 30.8%

Separated/Divorced/Widowed 21.2%

Unmarried, living with partner 14.8%

Education

High School 24.0%

Some College 18.4%

Completed four years college 34.4%

Five or more years of college 23.2%

Results

o Most women (n = 170, 68%) preferred to have annual screening even

if their provider suggested triennial screening

• of these women, 90% reported early cancer detection as the

reason for annual screening preference

o Other reasons for preferring annual testing

• history of an abnormal cancer screening

• fear/anxiety

• family history of cancer

• new partner/new exposure

o Most participants (n = 221, 88.4%) thought women their age should

have a Pap screening annually

o Most participants (n = 206, 82%) felt their chances of getting cervical

cancer were low chance to no chance

Clinical Implications

o Patient acceptance of the changes in cervical cancer screening

recommendations has been slow

o There is a gap between implementation of evidence-based

guidelines and actual practice

o There is a need for patient education about human

papillomavirus, the pathogenesis of cervical cancer, and the

evidence that supports the screening recommendations

References

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Haggerty, J., Tudiver, F., Brown, J. B., Herbert, C., Ciampi, A., & Guibert, R. (2005). Patients' anxiety and expectations: How

they influence family physicians' decisions to order cancer screening tests. Can Fam Physician, 51, 1658-1659.

Hawkins, N. A., Benard, V. B., Greek, A., Roland, K. B., Manninen, D., & Saraiya, M. (2013). Patient knowledge and beliefs

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