Dear HIFA colleagues,
I found this literature review interesting. The authors found that 'clinic workflow re-design strategies showed the greatest promise in improving cervical cancer screening rates' while 'education strategies for patients had mixed results, and quality management strategies were not effective'.
CITATION: Bonuck KJ, Angier H, McCrimmon S, et al. A Scoping Literature Review on Evidence-Based Strategies to Increase Cervical Cancer Screening. Journal of Primary Care & Community Health. 2023;14. doi:10.1177/21501319231220994
https://journals.sagepub.com/doi/10.1177/21501319231220994
ABSTRACT: Previous reviews of strategies to increase cervical cancer screening are more than 10 years old, the U.S. continues to fall short of the Healthy People 2030 cervical cancer screening goal, and guidelines were revised in 2018, therefore an updated review of the existing literature is needed. We conducted a scoping review using electronic databases PubMed, Scopus, and Ovid Medline that included publication dates between 2012 and 2021 to answer the question, “Which strategies implemented in U.S. primary care settings have been most successful in increasing rates of cervical cancer screening since the 2012 US Preventative Services Task Force cervical cancer screening guidelines were published?” We mapped findings to pre-specified implementation strategy categories. After initially identifying 399 articles, we excluded 350 due to duplicates or not meeting review criteria, leaving 49 articles for full review. We excluded 37 of these during full-text review and identified 2 additional articles from the manual search of reference lists for a total of 14 studies for abstraction. Eleven articles reported on strategies resulting in increased cervical cancer screening, and 3 did not. Clinic workflow re-design strategies showed the greatest promise in improving cervical cancer screening rates, education strategies for patients had mixed results, and quality management strategies were not effective. These findings suggest clinical workflow re-structures and patient education strategies can increase cervical cancer screening in primary care settings. Results are particularly important in settings that care for underserved populations, as these settings may need additional implementation strategies to decrease cervical cancer screening disparities.
EXTRACTS FROM THE FULL TEXT
Several barriers to receipt of guideline-concordant care have been identified, including patient-level barriers due to lack of knowledge, fear of screening, problems with transportation or time-off, and lack of physician recommendations. System-level barriers also exist, including lack of funding for follow up care, healthcare personnel shortages, limited patient outreach, lack of equipment, and inconsistent compensation for screening.
Restructuring strategies varied from workflow changes that transferred responsibilities from clinicians to medical assistants, or incorporating the use HPV self-tests in the office or by mail, use of information technology to identify and track patients, and mailing reminders to targeted patients overdue or at high risk.
I haven't been able to find a globl literature review on this topic. If you are aware of any studies, please email hifa@hifaforums.org with your observations.
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org