A single‐visit cervical carcinoma prevention program offered at an inner city church

Holschneider, Christine H.; Felix, Janine F.; Satmary, Wendy; Johnson, Michael T.; Sandweiss, Lynn; Montz, F.J.

doi:10.1002/(sici)1097-0142(19991215)86:12<2659::aid-cncr10>3.3.co;2-j

Cited by 8 publications

(8 citation statements)

References 16 publications

(19 reference statements)

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“…105 Other uncontrolled strategies that use same-day screening in emergency departments 128,129 or churches 130 have been reported to be feasible and to increase Papanicolaou smear use. These opportunistic screening strategies might also be more resource intensive and require reservation of personnel and facilities for performance of screening on demand.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Interventions to Increase Papanicolaou Smear Use

Yabroff

Mangan²,

Mandelblatt³

2003

The Journal of the American Board of Family Medicine

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Background: Many women fail to adhere to Papanicolaou smear screening guidelines. Although many interventions have been developed to increase screening, the effectiveness of different types of interventions is unclear.Methods: We performed a systematic review of interventions to increase Papanicolaou smear use published between 1980 and April 2001 and included concurrently or randomized controlled studies with defined outcomes. Interventions were classified as targeted to patients, providers, patients and providers, or health care systems and as behavioral, cognitive, sociologic, or a combination based on the expected action of the intervention. Effect sizes and 95% confidence intervals were calculated for each intervention.Results: Forty-six studies with 63 separate interventions were included. Most interventions increased Papanicolaou smear use, although in many cases the increase was not statistically significant. Behavioral interventions targeted to patients (eg, mailed or telephone reminders) increased Papanicolaou smear use by up to 18.8%; cognitive and sociologic interventions were only marginally effective, although a single culturally specific, sociologic intervention using a lay health worker increased use by 18.0% (95% confidence interval [CI]: 7.6, 28.4). Provider-targeted interventions were heterogeneous. Interventions that targeted both patients and providers did not appear to be any more effective than interventions targeted to either patients or providers alone. One of the most effective interventions, which introduced a system change by integrating a nurse-practitioner and offered same-day screening, increased screening by 32.7% (95% CI: 20.5, 44.9). Screening with regular Papanicolaou smears can decrease not only cervical cancer mortality but also the incidence of invasive disease. Conclusions1,2 Despite increases in recent Papanicolaou smear use during the past two decades, 3,4 with national estimates of approximately 80% within the past 3 years, 4 some women still fail to adhere to recommended Papanicolaou smear screening guidelines, are found to have advanced disease, and die of invasive cervical cancer.27-29 Thus, the potential benefits of routine screening are not being fully realized. Increasing the provision of Papanicolaou smear counseling by primary care providers and, ultimately, routine Papanicolaou smear use are important components of current Healthy People 2010 goals for reducing cervical cancer mortality. 30Physician recommendation is one of the strongest predictors of screening use, 13,17,[31][32][33][34][35][36][37] but in many cases, women report that their provider did not recommend Papanicolaou smears. 5,7,18,38 -45 Explanations for this behavior include lack of time, busy schedules and forgetfulness, 46,47 screening efficacy in the absence of symptoms or concern about proficiency, 31,48 or confusion about conflicting professional recommendations. 46 In the absence of a physician recommendation, patients might assume that screening is unnecessary.Women who do not receiv...

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Section: Discussionmentioning

confidence: 99%

Effectiveness of Interventions to Increase Papanicolaou Smear Use

Yabroff

Mangan²,

Mandelblatt³

2003

The Journal of the American Board of Family Medicine

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“…Currently, the majority of interventions to improve diagnostic follow‐up of abnormal screening tests conducted at any of the levels in our MIRDI model have been conducted among women with abnormal Papanicolaou (Pap) tests 5, 23–28, 30–38. Several interventions have been conducted to increase follow‐up in women with abnormal mammograms or clinical breast examinations 35, 39.…”

Section: Lessons Learnedmentioning

confidence: 99%

“…Using a quasiexperimental design, Kaplan et al28 tested a computerized tracking system and centralization of follow‐up services, accompanied by transportation and financial incentives, among indigent women and found only modest intervention effects. Other successful practice‐level interventions have addressed issues related to appropriate referral, including same‐day follow‐up of abnormal Pap smears31 or of abnormal flexible sigmoidoscopy42 with on‐site colposcopy or colonoscopy, respectively. Patient navigators,43 case management systems,32 and tracking systems44 have also been evaluated, but in uncontrolled settings that preclude assessment of effectiveness.…”

Section: Lessons Learnedmentioning

confidence: 99%

Interventions to improve follow-up of abnormal findings in cancer screening

Bastani

Yabroff

Ph.D.

et al. 2004

Cancer

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The potential reduction in morbidity and mortality through cancer screening cannot be realized without receipt of appropriate follow-up care for abnormalities identified via screening. In this paper, the authors critically examine the existing literature on correlates of receipt of appropriate follow-up care for screen-detected abnormalities, as well as the literature on interventions designed to increase rates of receipt of follow-up care. Lessons learned describe what is known and not known about factors that are related to or predict receipt of follow-up care.Similarly, effective interventions to increase follow-up are described and gaps identified. A conceptual model is developed that categorizes the health care system in the United States as comprising four levels: policy, practice, provider, and patient. Some patient-level factors that influence follow-up receipt are identified, but the lack of data severely limit the understanding of provider, practice, and A long the continuum from cancer screening through diagnosis, treatment, and rehabilitation, little attention has focused on intervening to assure timely, effective diagnosis once an abnormality has been identified. To achieve the goal of reducing cancer morbidity and mortality, it is imperative that patients receive timely and appropriate follow-up for detected abnormalities, as a prerequisite to appropriate treatment. Failure to obtain appropriate diagnostic services can have a significant effect on psychosocial sequelae, morbidity, and mortality, as well as cost implications for the individual and the health care system. A recent review of studies on follow-up of abnormal screening examinations reported that, in the majority of studies, fewer than 75% of patients receive adequate follow-up care. 1 The negative implications of failure to follow-up are substantial, especially at the population level.

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“…[16][17][18][19][20][21] A loop electrosurgical excision procedure (LEEP) is performed immediately under local anaesthesia when the colposcopist is convinced that the cervical lesion is a high-grade CIN. The overtreatment rate for this procedure varies between 13.3 and 83.3%, 17 with a subsequent risk of morbidity (haemorrhage, infection, and cervical stenosis), 16,22,23 and with an increased risk of future premature labour as a result of cervical insufficiency.…”

Section: Introductionmentioning

confidence: 99%

Evidence supporting see‐and‐treat management of cervical intraepithelial neoplasia: a systematic review and meta‐analysis

Ebisch

Rovers

Bosgraaf

et al. 2015

BJOG

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Background Studies of see-and-treat management of cervical intraepithelial neoplasia (CIN) vary in their inclusion criteria, resulting in a broad range of overtreatment rates.Objectives To determine overtreatment rates in see-and-treat management of women referred for colposcopy because of suspected CIN, in order to define circumstances supporting seeand-treat management.Search strategy MEDLINE, EMBASE, and the Cochrane Library were searched from inception up to 12 May 2014.Selection criteria Studies of see-and-treat management in women with a reported cervical smear result, colposcopic impression, and histology result were included.Data collection and analysis Methodological quality was assessed with the Newcastle-Ottawa scale. We used the inverse variance method for pooling incidences, and a random-effects model was used to account for heterogeneity between studies. Overtreatment was defined as treatment in patients with no CIN or CIN1.Main results Thirteen studies (n = 4611) were included. The overall overtreatment rate in women with a high-grade cervical smear and a high-grade colposcopic impression was 11.6% (95% CI 7.8-15.3%). The overtreatment rate in women with a high-grade cervical smear and low-grade colposcopic impression was 29.3% (95% CI 16.7-41.9%), and in the case of a low-grade smear and high-grade colposcopic impression it was 46.4% (95% CI 15.7-77.1%). In women with a low-grade smear and low-grade colposcopic impression, the overtreatment rate was 72.9% (95% CI 68.1-77.7%).Author's conclusions The pooled overtreatment rate in women with a high-grade smear and high-grade colposcopic impression is at least comparable with the two-step procedure, which supports the use of see-and-treat management in this subgroup of women.Keywords Cervical intraepithelial neoplasia, cervical smear, colposcopy, large loop excision of the transformation zone, overtreatment, see-and-treat.Tweetable abstract See-and-treat management is justified in the case of a high-grade smear and a high-grade colposcopic impression.

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A single‐visit cervical carcinoma prevention program offered at an inner city church

Cited by 8 publications

References 16 publications

Effectiveness of Interventions to Increase Papanicolaou Smear Use

Effectiveness of Interventions to Increase Papanicolaou Smear Use

Interventions to improve follow-up of abnormal findings in cancer screening

Evidence supporting see‐and‐treat management of cervical intraepithelial neoplasia: a systematic review and meta‐analysis

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