Incorporation of human papillomavirus self-sampling into the revised National Cervical Screening Program: a qualitative study of GP experiences and attitudes in rural New South Wales

Abstract

Human papillomavirus self-sampling is part of the revised Australian National Cervical Screening Program for eligible under- or never-screened women. Although research demonstrates self-sampling as an acceptable method from the perspective of women, little is known about GP experiences and perspectives of this new screening alternative. This study sought to explore the experiences and perspectives of rural GPs towards the revised National Cervical Screening Program and the new self-sampling option. Semistructured qualitative interviews were completed with 12 GPs in central west New South Wales. The study found that GPs had limited experience facilitating self-sampling. The limited provision of education, difficulty accessing testing kits, poor availability of accredited laboratories and unclear rebate guidelines hindered their capacity to offer self-sampling. GPs reported uncertainty around patient eligibility and the quality of self-collected samples. GPs explained that self-sampling could increase cervical screening participation among some women, but because it is only available to complete in a general practice, it would not benefit those who are disengaged from health services. Despite GPs’ limited experience with facilitating self-sampling to date, they were optimistic about potential increases in cervical screening rates. Clearer articulation of specific program details and the evidence underpinning the program changes would reduce clinician uncertainty regarding the practicalities of how to incorporate patient-collected sampling into their daily practice, as well as the quality of patient-collected samples compared with clinician-collected samples. GPs must also be supported at a systems level to ensure there are processes in place to enable easy access to kits, laboratories, Medicare rebates and relevant support.

“So, if she wasn’t aware of it, then how would everybody else out there be aware of it?”—Key Stakeholder Perspectives on the Initial Implementation of Self-Collection in Australia’s Cervical Screening Program: A Qualitative Study

“…Very limited promotion regarding the availability of self-collection to both consumers and health care providers has very likely contributed to a substantially low adoption of restricted self-collection in the first two years of the renewed program [ 33 ]. Among primary care practitioners, there appears to be the strong misconception that self-collection is inferior compared to a clinician-collected HPV samples [ 27 , 31 , 34 ] with similar findings have been documented elsewhere [ 28 , 29 , 32 ]. At the time of the policy decision in Australia (in around 2014), the early evidence suggested that, while HPV testing on a self-collected sample had a greater sensitivity than Pap testing, it was slightly inferior to HPV testing on a clinician-collected sample, because many of the studies had used HPV tests based on signal-amplification assays rather than PCR-based assays [ 35 ].…”

“…The National Cancer Screening Register now has a healthcare provider portal with integration with some commonly used practice management software, which may overcome this sort of issue in future (and it is now less of a barrier as there is universal access to self-collection). It is important that the system level issues reported by our study and elsewhere, which may have contributed to a general confusion and mistrust of self-collection [ 27 , 31 , 32 ] are successfully addressed and practitioner attitudes changed moving forward.…”

“…We demonstrated that the lack of promotion of self-collection not only contributed to low adoption and support for implementation amongst primary care, but also to the misconception by some that self-collection is an inferior test in comparison to clinician-collected [ 27 , 28 , 29 , 31 ]. Very limited promotion regarding the availability of self-collection to both consumers and health care providers has very likely contributed to a substantially low adoption of restricted self-collection in the first two years of the renewed program [ 33 ].…”

Aboriginal and Torres Strait Islander women's views of cervical screening by self‐collection: a qualitative study

“…46 Evidence suggests that healthcare professionals consider self-collection as a valuable option, particularly for under-and never-screened women, but they remain uncertain and hesitant about its efficacy and continue to view clinician-collected samples as the gold standard. 25,[46][47][48] Despite it being highly anticipated, there were delays to the introduction of selfcollection. This was largely due to the need for laboratories to conduct and have approved their own in-house validation to process self-collected samples; only one laboratory had done so in Australia when self-collection was introduced.…”

“…It highlights the need to ensure that clinicians are aware of self‐collection and are confident in recommending it to their clientele 46 . Evidence suggests that healthcare professionals consider self‐collection as a valuable option, particularly for under‐ and never‐screened women, but they remain uncertain and hesitant about its efficacy and continue to view clinician‐collected samples as the gold standard 25,46-48 …”