scholarly journals Cervical cancer screening strategies for evidence-based health care reform in China: a multicentre, open-label randomised trial

The Lancet ◽  
2019 ◽  
Vol 394 ◽  
pp. S20
Author(s):  
Junji Zhang ◽  
Yuqian Zhao ◽  
Yi Dai ◽  
Le Dang ◽  
Li Ma ◽  
...  
Keyword(s):  
Health Care ◽  
Cervical Cancer ◽  
Cancer Screening ◽  
Health Care Reform ◽  
Cervical Cancer Screening ◽  
Randomised Trial ◽  
Evidence Based ◽  
Open Label ◽  
Screening Strategies ◽  
Evidence Based Health Care

scholarly journals Ending Cervical Cancer Screening in Low-Risk Women After Age 65

2018 ◽  
Vol 5 ◽  
pp. 233339281875524
Author(s):  
Emily Boone ◽  
Michael Karp ◽  
LaVonna Lewis
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Primary Care Providers ◽  
Low Risk ◽  
Evidence Based ◽  
Care Providers ◽  
Low Risk Women

Background: Current evidence-based cervical cancer testing guidelines recommend that screening of low-risk women ceases after age 65. Despite this, research suggests that continued testing by primary care providers remains common and represents unnecessary patient discomfort, cost, and consumption of valuable primary care resources. Objective: To understand why primary care providers might knowingly ignore consensus evidence-based screening guidelines for cervical cancer in low-risk women of this age-group and to identify barriers to adherence with best practice recommendations. Methods: A survey tool to identify barriers to adherence with current guidelines for cervical cancer screening in low-risk women older than age 65 was mailed to 4929 randomly selected primary care providers throughout California. Providers were asked to indicate the predominant reason(s) they might knowingly continue cervical cancer screening in women older than 65 years, despite evidence-based recommendations to the contrary. Results: Qualified surveys were received from 1259 (25.5%) of those surveyed, representing primary care providers of all types, practicing in areas of vastly different demographics. Despite published reassurance to the contrary, many providers retain fear that discontinuation of testing in low-risk women after age 65 may result in missed invasive cervical cancer. Even among health-care providers who agree that cessation of screening is safe, other circumstances prompt their recommendation to continue cervical screening. Conclusion: Although the data from this study suggest areas of policy intervention to lessen unnecessary cervical cancer screening, the broader implication is that advancement of evidence-based medicine will be of little value in improving the quality and cost of health care if barriers to guideline adherence are poorly understood and addressed.

scholarly journals “They Should Be Asking Us”: A Qualitative Decisional Needs Assessment for Women Considering Cervical Cancer Screening

2018 ◽  
Vol 5 ◽  
pp. 233339361878363 ◽  
Author(s):  
Brianne Wood ◽  
Virginia L. Russell ◽  
Ziad El-Khatib ◽  
Susan McFaul ◽  
Monica Taljaard ◽  
...  
Keyword(s):  
Health Care ◽  
Cervical Cancer ◽  
Decision Making ◽  
Cancer Screening ◽  
Shared Decision Making ◽  
Cervical Cancer Screening ◽  
Cervical Screening ◽  
Hpv Testing ◽  
Shared Decision ◽  
Care Providers

In this study, we examine from multiple perspectives, women’s shared decision-making needs when considering cervical screening options: Pap testing, in-clinic human papillomavirus (HPV) testing, self-collected HPV testing, or no screening. The Ottawa Decision Support Framework guided the development of the interview schedule. We conducted semi-structured interviews with seven screen-eligible women and five health care professionals (three health care providers and two health system managers). Women did not perceive that cervical screening involves a “decision,” which limited their knowledge of options, risks, and benefits. Women and health professionals emphasized how a trusted primary care provider can support women making a choice among cervical screening modalities. Having all cervical screening options recommended and funded was perceived as an important step to facilitate shared decision making. Supporting women in making preference-based decisions in cervical cancer screening may increase screening among those who do not undergo screening regularly and decrease uptake in women who are over-screened.

scholarly journals Barriers to cervical cancer screening in Guatemala: a quantitative analysis using data from the Guatemala Demographic and Health Surveys

2019 ◽  
Vol 65 (2) ◽  
pp. 217-226 ◽  
Author(s):  
Anna Gottschlich ◽  
Pamela Ochoa ◽  
Alvaro Rivera-Andrade ◽  
Christian S. Alvarez ◽  
Carlos Mendoza Montano ◽  
...  
Keyword(s):  
Health Care ◽  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Health Surveys ◽  
Indigenous Communities ◽  
Demographic And Health Surveys ◽  
Barriers To Health Care ◽  
Screening Programs ◽  
Barriers To Health

Abstract Objectives Examine the association between commonly reported barriers to health care, including discordant spoken languages between patients and providers, and reported previous cervical cancer screening. Methods Data from the nationally representative Guatemala National Maternal and Child Health Survey from the Demographic and Health Surveys Program were used to explore associations between barriers and screening rates nationwide and in high-risk populations, such as rural and indigenous communities. Negative binomial regressions were run accounting for survey sample weights to calculate prevalence ratios. Results 64.0%, 57.5% and 47.5% of women reported ever screening, in the overall, indigenous, and rural populations, respectively. Overall, never screened for cervical cancer was associated with the following health barriers: needing permission, cost, distance, not wanting to go alone, and primary language not spoken by health providers, even after adjustment for age, ethnicity, and literacy. Conclusions Offering screening programs alone is not enough to reduce the burden of cervical cancer in Guatemala. Measures need to be taken to reduce barriers to health care, particularly in rural areas, where screening rates are lowest.

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