Factors Associated With Guideline-Concordant Cervical Cancer Screening Exit: A Mixed Methods Study.

IF 2.5 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Abigael Olson, Lindsay Fuzzell, Naomi C Brownstein, Holly B Fontenot, Alexandra Michel, Paige Lake, Susan T Vadaparampil, Rebecca B Perkins
{"title":"Factors Associated With Guideline-Concordant Cervical Cancer Screening Exit: A Mixed Methods Study.","authors":"Abigael Olson, Lindsay Fuzzell, Naomi C Brownstein, Holly B Fontenot, Alexandra Michel, Paige Lake, Susan T Vadaparampil, Rebecca B Perkins","doi":"10.1016/j.whi.2025.07.006","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>More than 20% of cervical cancers are diagnosed in women older than 65 years. Guidelines recommend screening exit at age 65 for average-risk patients only if certain criteria are met, yet most women aged 64-66 years in the United States are inadequately screened. In this mixed methods study, we explored clinician knowledge of exit criteria.</p><p><strong>Methods: </strong>We explored factors associated with clinician-reported guideline-concordant screening exit, as well as facilitators and barriers to appropriate cervical cancer screening exit. Guideline concordance required that clinicians be aware that patients can exit screening if they have received a hysterectomy for benign reasons or had either three consecutive negative Pap tests or two consecutive negative human papilloma virus tests-and that they should not exit screening if they have a history of precancer treatment in the prior 25 years.</p><p><strong>Results: </strong>In 2021, a national sample of 1,251 clinicians completed surveys; a subset (n = 55) completed qualitative interviews. Although most (>70%) correctly identified criteria related to hysterectomy and prior negative screening requirements, only 35% of participants (n = 434) responded correctly to all screening exit items. In logistic regression models, male clinicians, OB/GYNs, and those in academic or hospital-based practices were more likely to respond correctly. Interview responses indicated variable understanding of the nuances of exit criteria. Those who continued screening patients past age 65 cited concerns related to new sexual partners and missing cancers. Several providers noted difficulty accessing adequate records.</p><p><strong>Conclusions: </strong>Clinicians who routinely perform cervical cancer screening have knowledge gaps around exit criteria and also describe difficulty applying the criteria in practice. As fewer women undergo hysterectomy and life expectancy increases, the number of individuals older than 65 at risk for cervical cancer will continue to rise. Adjusting guidelines to decrease the complexity of exit criteria should be considered.</p>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":" ","pages":""},"PeriodicalIF":2.5000,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Womens Health Issues","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.whi.2025.07.006","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
引用次数: 0

Abstract

Background: More than 20% of cervical cancers are diagnosed in women older than 65 years. Guidelines recommend screening exit at age 65 for average-risk patients only if certain criteria are met, yet most women aged 64-66 years in the United States are inadequately screened. In this mixed methods study, we explored clinician knowledge of exit criteria.

Methods: We explored factors associated with clinician-reported guideline-concordant screening exit, as well as facilitators and barriers to appropriate cervical cancer screening exit. Guideline concordance required that clinicians be aware that patients can exit screening if they have received a hysterectomy for benign reasons or had either three consecutive negative Pap tests or two consecutive negative human papilloma virus tests-and that they should not exit screening if they have a history of precancer treatment in the prior 25 years.

Results: In 2021, a national sample of 1,251 clinicians completed surveys; a subset (n = 55) completed qualitative interviews. Although most (>70%) correctly identified criteria related to hysterectomy and prior negative screening requirements, only 35% of participants (n = 434) responded correctly to all screening exit items. In logistic regression models, male clinicians, OB/GYNs, and those in academic or hospital-based practices were more likely to respond correctly. Interview responses indicated variable understanding of the nuances of exit criteria. Those who continued screening patients past age 65 cited concerns related to new sexual partners and missing cancers. Several providers noted difficulty accessing adequate records.

Conclusions: Clinicians who routinely perform cervical cancer screening have knowledge gaps around exit criteria and also describe difficulty applying the criteria in practice. As fewer women undergo hysterectomy and life expectancy increases, the number of individuals older than 65 at risk for cervical cancer will continue to rise. Adjusting guidelines to decrease the complexity of exit criteria should be considered.

与指南一致的宫颈癌筛查退出相关的因素:一项混合方法研究。
背景:超过20%的宫颈癌在65岁以上的妇女中被诊断出来。指南建议65岁的平均风险患者只有在满足某些标准的情况下才能退出筛查,然而在美国,大多数64-66岁的女性没有得到充分的筛查。在这项混合方法研究中,我们探讨了临床医生对退出标准的了解。方法:我们探讨与临床报告的指南相符的筛查退出相关的因素,以及适当的宫颈癌筛查退出的促进因素和障碍。指南一致性要求临床医生意识到,如果患者因良性原因接受了子宫切除术,或者连续三次宫颈涂片检查呈阴性或连续两次人乳头瘤病毒检查呈阴性,则可以退出筛查,如果他们在过去25年内有癌前治疗史,则不应该退出筛查。结果:2021年,全国1251名临床医生完成了调查;一个子集(n = 55)完成了定性访谈。虽然大多数(约70%)正确识别了与子宫切除术和既往阴性筛查要求相关的标准,但只有35%的参与者(n = 434)正确回答了所有筛查退出项目。在逻辑回归模型中,男性临床医生、妇产科医生和那些在学术或医院实践的医生更有可能做出正确的反应。访谈反应表明对退出标准的细微差别理解不一。那些65岁以上的患者继续接受筛查的人表示,他们担心会有新的性伴侣和遗漏癌症。一些供应商指出难以获得充分的记录。结论:常规进行宫颈癌筛查的临床医生在退出标准方面存在知识空白,并且在实践中应用标准也存在困难。由于接受子宫切除手术的妇女越来越少,而预期寿命增加,65岁以上有患子宫颈癌风险的人数将继续增加。应考虑调整指导方针,以降低退出标准的复杂性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
4.50
自引率
6.20%
发文量
97
审稿时长
32 days
期刊介绍: Women"s Health Issues (WHI) is a peer-reviewed, bimonthly, multidisciplinary journal that publishes research and review manuscripts related to women"s health care and policy. As the official journal of the Jacobs Institute of Women"s Health, it is dedicated to improving the health and health care of all women throughout the lifespan and in diverse communities. The journal seeks to inform health services researchers, health care and public health professionals, social scientists, policymakers, and others concerned with women"s health.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信