Patient, provider, and clinic factors associated with the use of cervical cancer screening

Abstract

Cervical cancer screening delivery remains suboptimal. Understanding the multiple influences on use of screening is important to designing interventions. We describe the influence of patient, primary care provider (PCP), and clinic characteristics on whether a woman is up-to-date with cervical screening as of December 2016. PCPs (n = 194) and their female screen-eligible patients age 21–65 years (n = 32,115) were included in this cross-sectional analysis of patients from two primary care networks linked to a contemporaneous PCP survey. Principal independent variables for patients included : age, race, insurance, continuity of care; for PCP included : overall satisfaction with the practice of medicine, gender, hours worked per week, financial support for achieving clinical targets; and for clinic included : routine receipt of data on preventive care performance and language translation resources. Overall, 66.6% of women were up-to-date. Women were less likely to be up-to-date with cervical cancer screening if they were younger and were more likely to be screened if they were Black, Hispanic or Asian vs. White. Women with greater continuity of primary care or with a female PCP were more likely to be up-to-date (1.52; 1.33–1.75); those who received care in a clinic that was less prepared to manage language translation were less likely to be up-to-date (0.78; 0.65–0.95). Patient, provider, and clinic factors all influence use of cervical cancer screening. Systems interventions like improving continuity of care, promoting translation services, or enhanced efforts to track screening among patients of male PCPs may improve delivery.

Organized Breast and Cervical Cancer Screening: Attendance and Determinants in Rural China

“…Organizer-level factors were measured with the following six items: notified about two-cancer screening (response options: yes or no, and yes had the following options: notification by GPs, friends/relatives, community women’s leaders, other community leaders); travel time to the hospital (response options: <15 min, 15–29 min, ≥30 min); received report within 2 weeks of screening; received report as of now; continuity of screening; overall perceived smoothness and usefulness of this screening program (response options of the above: yes or no) [ 12 , 20 , 24 , 29 , 30 ]. Provider-level factors were measured using six items: waiting time in the hospital (response options: <15 min, 15–29 min, ≥30 min); doctor’s explanations unclear; ward cleanliness; ward quietness; presence of others during examination; received health education (response options for the above: yes or no) [ 9 , 20 , 23 , 28 ]. Receiver-level factors included sociodemographic characteristics and disease-related characteristics [ 6 , 9 , 15 , 21 ].…”

“…Conceptual models suggest that variation in attendance at two-cancer screening occurs at multiple levels, especially involving the receiver (individual women), provider, and organizer of screening; most of the literature has focused on receiver-related factors [ 17 , 18 , 19 , 20 ]. Younger, being unmarried, and having no children predict lower screening attendance, and previous experience with cervical abnormalities substantially predicts higher screening attendance.…”

“…Younger, being unmarried, and having no children predict lower screening attendance, and previous experience with cervical abnormalities substantially predicts higher screening attendance. However, the association of education level, income, type of employment, and knowledge of screening with attendance are inconsistent among existing studies [ 20 , 21 , 22 , 23 , 24 ]. Provider-related factors, such as lack of GPs, educational intervention, and recommendations, as well as the distance to the screening site, have been associated with low screening attendance [ 20 , 21 ].…”

“…However, the association of education level, income, type of employment, and knowledge of screening with attendance are inconsistent among existing studies [ 20 , 21 , 22 , 23 , 24 ]. Provider-related factors, such as lack of GPs, educational intervention, and recommendations, as well as the distance to the screening site, have been associated with low screening attendance [ 20 , 21 ]. However, few studies have empirically measured providers’ performance with respect to screening attendance.…”

“…However, few studies have empirically measured providers’ performance with respect to screening attendance. Given the multiple steps and interfaces involved in organized two-cancer screening, organizer-related factors such as the source of notification about screening, access to screening, feedback about screening results, and promoting referrals are essential for the delivery of cancer screening [ 20 , 24 , 25 ]. Yet the corresponding data are scarce.…”