A cross‐sectional survey examining clinician characteristics, practices, and attitudes associated with adoption of the 2019 American Society for Colposcopy and Cervical Pathology risk‐based management consensus guidelines

Abstract

BackgroundThe 2019 American Society for Colposcopy and Cervical Pathology (ASCCP) risk‐based management consensus guidelines are the most recent national guidelines for the management of abnormal cervical cancer screening tests. These guidelines benefit patients by concentrating testing and treatment in those at highest cervical cancer risk. Adoption of guidelines often occurs slowly, with few studies examining the factors associated with guideline‐adherent management of abnormal results.MethodsTo elucidate the factors associated with the use of the 2019 ASCCP guidelines among clinicians who perform cervical cancer screening, physicians and advanced practice professionals who perform cervical cancer screening were cross‐sectionally surveyed. Clinicians responded to screening vignettes with differing recommendations for management between the 2019 and prior management guidelines. Screening vignette 1 involved reduction of invasive testing on a low‐risk patient; screening vignette 2 involved increased surveillance testing on a high‐risk patient. Binomial logistic regression models determined the factors associated with the use of the 2019 guidelines.ResultsA total of 1251 clinicians participated from across the United States. For screening vignettes 1 and 2, guideline‐adherent responses were given by 28% and 36% of participants, respectively. Management recommendations differed by specialty and were incorrect in different situations: there was inappropriate invasive testing by obstetrics and gynecology physicians (vignette 1) and inappropriate discontinuation of screening by family and internal medicine physicians (vignette 2). Regardless of their chosen response, over half erroneously believed they were guideline adherent.ConclusionsMany clinicians who believe they are following appropriate guidelines may not realize their management strategy is inconsistent with the 2019 guidelines. Education initiatives tailored to clinician specialty could address the understanding of current guidelines, encourage the use of updated guidelines, maximize patient benefits, and minimize harms.Plain Language Summary The 2019 American Society for Colposcopy and Cervical Pathology risk‐based management consensus guidelines are the most recent national guidelines for abnormal cervical cancer screening test management. We surveyed over 1200 obstetrics and gynecology (OB/GYN), family medicine, and internal medicine physicians and advanced practice providers about their screening and abnormal results follow‐up practices in relation to guidelines. Few clinicians are following the 2019 guidelines. Management recommendations differed by clinician specialty and were incorrect in different situations: there was inappropriate invasive testing by OB/GYN physicians and inappropriate screening discontinuation by family and internal medicine physicians. Education tailored by clinician specialty could address the understanding of current guidelines, encourage the use of updated guidelines, maximize patient benefits, and minimize harms.

Attitudes toward the American Cancer Society’s 2020 cervical cancer screening guidelines: A qualitative study of a national sample of US clinicians

“…The first was a national study of clinicians from various clinical settings. A full description of the methodology has been published elsewhere, 19 but briefly, participants were recruited to participate in a survey via email between March and August 2021 from the National Association of Nurse Practitioners in Women's Health, the American Society of Colposcopy and Cervical Pathology (ASCCP), and Dynata (an online market research firm). The second was a supplemental study using similar methodology but limited to clinicians practicing in federally qualified health centers; participants were recruited between October 2021 and July 2022.…”

“…17 Adoption occurs slowly; research performed in 2022 found that 75% of clinicians had adopted guidelines released in 2012 but only one third had adopted updates released in 2019. 16,18,19 Hence, it is foreseeable that clinicians will become more accepting of primary HPV screening and initiating screening at age 25 years over time. Increased uptake of these guidelines could be achieved if multiple professional societies endorse the use of primary HPV testing as a primary screening strategy.…”