Dr Rachael Dodd

Abstract

Implementing renewal of the Cervical Screening Program in Australia: Health Professionals' views and experiences

Rachael H Dodd, Helena M Obermair, Kirsten J McCaffery

1  Wiser Healthcare, School of Public Health, The University of Sydney, Camperdown, NSW, Australia
2 Liverpool Hospital, South-West Sydney Local Health District, Liverpool, NSW, Australia

In 2017, the Australian National Cervical Screening Program changed from two-yearly Pap smears for women aged 18-69, to five-yearly human papillomavirus (HPV) tests for women aged 25-74. Recent research has shown that women may be concerned about these screening changes. Health professionals have been shown to be influential when changes occur or when recommendations are required. Research with health professionals practising in Australia was conducted prior to the renewal of the cervical screening program, but attitudes since the implementation of the renewed program are unknown.

This study aims to explore the attitudes and experiences of health professionals practising in Australia towards the renewed National Cervical Screening Program.

Semi-structured interviews were conducted with 31 health professionals in Australia who are involved in cervical screening in November and December 2018. This included general practitioners, obstetricians & gynaecologists, gynaecological oncologists, pathologists and nurses. The interviews were analysed using thematic analysis.

In total, 31 health professionals were interviewed. Overall, health professionals had positive attitudes to the renewed cervical screening program. Four main themes emerged from the data: practical system challenges, communication and education, screening outside the guidelines and other unexpected downstream effects. Practical system challenges included increased colposcopy referrals, limited access to the National Cancer Screening Register, complex screening pathways and issues with self-collection. In terms of communication and education, the limited public education was recognised, in addition to challenges with particular age groups of women. Screening outside of the guidelines was described, for example over-referring women for co-testing by stating symptoms, which could lead to overtreatment. In addition, there was some description of self-collection guidelines not being followed. Other perceived collateral was demonstrated through reduced opportunistic screening opportunities due to less frequent primary care presentations, and a concern over the potential for further underscreening in those population groups who were already under screened.

Women's understanding and experience of the renewed National Cervical Screening Program will likely depend upon clinicians' ability and willingness to explain the rationale behind the changes, and to respond confidently to patient concerns regarding these changes. It is essential that concerns and challenges identified in this study are addressed with health professionals to improve implementation of this screening program and to provide guidance for future deimplementation of screening programs. These findings also provide insight into the challenges health professionals are facing with the renewed program, in terms of practical issues and unexpected downstream effects which need to be addressed. Addressing these challenges may also reduce screening outside of the guidelines and reduce the potential of overtreatment from over testing.