Examining the perceived impact of the COVID-19 pandemic on cervical cancer screening practices among clinicians practicing in Federally Qualified Health Centers: A mixed methods study

Abstract

Background:The COVID-19 pandemic led to reductions in cervical cancer screening and colposcopy. Therefore, in this mixed methods study we explored perceived pandemic-related practice changes to cervical cancer screenings in federally qualified health centers (FQHCs).Methods:Between October 2021 and June 2022, we conducted a national web survey of clinicians (physicians and advanced practice providers) who performed cervical cancer screening in FQHCs in the United States during the post-acute phase of the COVID-19 pandemic, along with a sub-set of qualitative interviews via video conference, to examine perceived changes in cervical cancer screening practices during the pandemic.Results:A total of 148 clinicians completed surveys; a subset (n=13) completed qualitative interviews. Most (86%) reported reduced cervical cancer screening early in the pandemic, and 28% reported continued reduction in services at the time of survey completion (October 2021- July 2022). Nearly half (45%) reported staff shortages impacting their ability to screen or track patients. Compared to clinicians in Obstetrics/Gynecology/Women’s health, those in family medicine and other specialties more often reported reduced screening compared to pre-pandemic. Most (92%) felt that screening using HPV self-sampling would be very or somewhat helpful to address screening backlogs. Qualitative interviews highlighted the impacts of staff shortages and strategies for improvement.Conclusions:Findings highlight that in late 2021 and early 2022, many clinicians in FQHCs reported reduced cervical cancer screening and of pandemic-related staffing shortages impacting screening and follow-up. If not addressed, reduced screenings among underserved populations could worsen cervical cancer disparities in the future.Funding:This study was funded by the American Cancer Society, who had no role in the study’s design, conduct, or reporting.

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

“…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 20 …”

“…An interview guide was developed on the basis of Cabana et al.’s Guideline Based Practice Improvement Framework 21 . Initial drafts of the interview guide were reviewed by an expert panel of primary care clinicians, refined, pilot tested, further revised, and then finalized 20, 22 . This article focuses on the responses to questions specific to the updated ACS guidelines.…”

“…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. 20 Eligibility criteria for both studies included the following: (1) being licensed as a physician (i.e., medical doctor [MD] or doctor of…”

“…21 Initial drafts of the interview guide were reviewed by an expert panel of primary care clinicians, refined, pilot tested, further revised, and then finalized. 20,22 This article focuses on the responses to questions specific to the updated ACS guidelines. Qualitative interviews in both studies used the same questions:…”