ASPO Abstracts
Provider Communication, Patient Preferences, and Overuse in Cervical Cancer Screening
Category: Early Detection & Risk Prediction
Conference Year: 2019
Abstract Body:
Purpose. To examine provider communication regarding different cervical cancer screening modalities and how it may shape overuse. Methods. Using electronic medical record data, we identified all women who received routine cervical cancer screening between April-June 2018 at the University of Pennsylvania Health System. Of the 467 women screened, 150 women were randomly selected to be invited to participate and 30 women enrolled. Eligibility for routine screening was confirmed during recruitment and all women identified as high-risk were excluded. A semi-structured interview guide was used to examine three domains: a) influential factors shaping screening modality decisions; b) potential strategies for decreasing overuse; and, c) perspectives on primary HPV testing. Participants also completed a structured questionnaire examining screening practices and beliefs. Interview data were analyzed using directed content analysis, and survey data were analyzed descriptively. Relationships between qualitative and quantitative data were analyzed using a concurrent mixed-methods approach. Results. The majority of women described little to no communication by their providers regarding different cervical cancer screening options. Most women (75.9%) stated that providers recommended Pap smears, but only 13.3% reported that they also recommended human papillomavirus (HPV) testing. Only 27.6% and 20.7% of women reported that providers discussed benefits or harms of screening, respectively. With regard to overuse, most women (76.7%) reported that they believed women should have Pap smears annually, and over half (53.3%) stated they would not feel comfortable discontinuing screening at age 65. However, 37.9% reported that they would be screened using primary HPV testing every 5 years if recommended by their provider. In the interviews, the majority of women discussed being open to different screening strategies (including primary HPV testing) if their provider communicated the differences between each modality and the evidence supporting their recommended approach. Conclusions. Strategies to increase adoption of evidence-based screening guidelines are needed including interventions designed to help providers clearly communicate the evidence supporting less frequent screening.
Keywords: Cervical Cancer ScreeningProvider CommunicationOveruse