Primary care provider practices and beliefs related to cervical cancer screening with the HPV test in Federally Qualified Health Centers

Roland, Katherine B.; Benard, Vicki B.; Greek, April; Hawkins, Nikki A.; Manninen, Diane L.; Saraiya, Mona

doi:10.1016/j.ypmed.2013.04.012

Cited by 40 publications

(44 citation statements)

References 39 publications

(28 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As FQHCs receive funding to expand clinical services (http://bphc.hrsa.gov/about/healthcenterfactsheet.pdf), providing evidence-based care is especially critical. However, as this study and previous research highlights, provider HPV vaccine recommendations and cervical cancer screening practices [23,28] in some FQHCs may not be consistent with U.S. guidelines. Effective integration of screening and immunization services to provide the maximum health benefit for women is a critical challenge [29].…”

Section: Discussionmentioning

confidence: 66%

“…It is not surprising that one-third of providers sometimes to always use sexual history to determine vaccination because these same providers also reported the number of their patient’s current (71%) and lifetime (67%) sexual partners as important factors to consider when determining her cervical cancer screening interval [23]. We do not know if pre-vaccination assessment using the number of sexual partners means providers are more or less likely to vaccinate against HPV.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Primary care providers human papillomavirus vaccine recommendations for the medically underserved: A pilot study in U.S. Federally Qualified Health Centers

Roland¹,

Benard²,

Greek³

et al. 2014

Vaccine

View full text Add to dashboard Cite

Introduction In the United States, Federally Qualified Health Centers (FQHCs) are safety-net clinics that provide cervical cancer screening and human papillomavirus (HPV) vaccination to medically underserved women, some of whom may be at risk for developing cervical cancer. National guidelines recommend against using screening test results or sexual history to determine vaccine eligibility. Documenting HPV vaccine recommendations and beliefs of primary care providers in FQHCs may aid in promoting evidence-based practices and prioritizing health interventions for vulnerable populations. Methods Between 2009 and 2010, we collected data from 98 primary care providers in 15 FQHC clinics in IL, USA using a cross-sectional survey. Questions assessed provider and practice characteristics, HPV vaccine recommendations, and provider’s belief about whether their screening and management procedures would change for women who were vaccinated. Results 93% of providers recommended the HPV vaccine, most frequently for females aged 13–26 years (98%). Some providers reported sometimes to always using HPV test results (12%), Pap test results (7%), and number of sexual partners (33%) to determine vaccine eligibility. More than half of providers (55%) reported they will not change their screening and management practices for vaccinated females, yet believe vaccination will yield fewer abnormal Pap tests (71%) and referrals for colposcopy (74%). Conclusion Study providers routinely recommended the HPV vaccine for their patients. However, providers made fewer recommendations to vaccinate females ages 9–12 years (which includes the target age for vaccination) compared to older females, and used pre-vaccination assessments not recommended by U.S. guidelines, such as screening test results and number of sexual partners. In order to maximize the public health benefit of the HPV vaccine to prevent cervical cancer, adherence to guidelines is necessary, especially in settings that provide care to medically underserved women.

show abstract

Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Primary care providers human papillomavirus vaccine recommendations for the medically underserved: A pilot study in U.S. Federally Qualified Health Centers

Roland¹,

Benard²,

Greek³

et al. 2014

Vaccine

View full text Add to dashboard Cite

show abstract

“…The majority of women in our study did not believe waiting longer between Pap tests would present benefits such as saving time, cost, and promoting peace of mind. Interestingly, only a minority of women believed waiting longer between tests would prevent them from getting other needed healthcare, a concern that is commonly expressed by medical care providers (Roland et al, 2013). …”

Section: Discussionmentioning

confidence: 99%

Patient knowledge and beliefs as barriers to extending cervical cancer screening intervals in Federally Qualified Health Centers

Hawkins¹,

Benard²,

Greek

et al. 2013

Preventive Medicine

View full text Add to dashboard Cite

Objective Despite guidelines recommending cervical cancer screening intervals be extended beyond one year, clinical practice has been slow to change. Patient preferences are a potential barrier. In the Centers for Disease Control's Cervical Cancer (Cx3) Study at Federally Qualified Health Centers (FQHCs) across Illinois, we surveyed patients about screening practices, and assessed beliefs regarding lengthening screening intervals. Method We analyzed data from 984 low income women in the Cx3 Study (2009–2011). Participants completed a survey assessing health history, knowledge about Pap testing, beliefs and intentions about extending screening intervals, and demographics. Results The majority reported annual Pap testing (61%), while only 24% reported a 2–3 year screening interval (recommendation at time of survey). Misunderstandings about the Pap test were prevalent, with over half believing it screened for vaginal, yeast, and sexually transmitted infections (58%–72%). Unfavorable beliefs about extending screening intervals were common. The majority (57%) indicated that they would not wait 3 years to be screened if their physician recommended it, and intentions were associated with knowledge about Pap testing. Conclusion Most women reported annual cervical cancer screening, and intended to resist longer screening intervals. Patients' lack of knowledge and unfavorable beliefs may serve as barriers to extending screening intervals. Published by Elsevier Inc.

show abstract

“…In one study, only 56% of the primary care physicians (PCPs) considered DES exposure moderately important when determining screening interval length among low-income women. 39 If under half the clinicians do not consider DES exposure an important factor in interval screening, this known high-risk group of women may not know the importance and recommendation of annual Pap smear exams. Results from this study show that DES exposure triples the odds for Pap smear nonutilization, making this group of women more vulnerable to gynecological cancer risk.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with a Lack of Pap Smear Utilization in Women Exposed In Utero to Diethylstilbestrol

Camp

Prehn

Shen

et al. 2015

Journal of Women's Health

View full text Add to dashboard Cite

Background: Women in the1940s-1960s were prescribed diethylstilbestrol (DES), a nonsteroidal estrogen, to prevent miscarriages, but the practice was terminated after it was discovered that the daughters so exposed in utero were at increased risk for developing clear cell adenocarcinoma (CCA) of the vagina or cervix at early ages. Pap smear screening is one of the principal methods used to identify tumor development and is necessary in this group of women to maintain their health. Currently, little is known about the factors associated with nonutilization of this screening tool in this high-risk population of women. Methods: National cohort data from the National Cancer Institute (NCI) DES Combined Cohort Follow-up Study during 1994, and 2006 were used to determine which factors were associated with Pap smear screening nonutilization in 2006 among DES-exposed and unexposed women. Self-reported questionnaire data from 2,861 DES-exposed and 1,027 unexposed women were analyzed using binary logistic regression models. Results: DES exposure, not having a previous gynecologic dysplasia diagnosis, lack of insurance, originating cohort, increasing age, and previous screening behavior were all factors associated with not reporting a Pap smear examination in the 2006 questionnaire, although college education reduced nonutilization. Conclusions: Understanding which factors are associated with not acquiring a screening exam can help clinicians better identify which DES-exposed women are at risk for nonutilization and possibly tailor their standard of care to aid in the early detection of cervical and vaginal adenocarcinomas in this high-risk group.

show abstract

Primary care provider practices and beliefs related to cervical cancer screening with the HPV test in Federally Qualified Health Centers

Cited by 40 publications

References 39 publications

Primary care providers human papillomavirus vaccine recommendations for the medically underserved: A pilot study in U.S. Federally Qualified Health Centers

Primary care providers human papillomavirus vaccine recommendations for the medically underserved: A pilot study in U.S. Federally Qualified Health Centers

Patient knowledge and beliefs as barriers to extending cervical cancer screening intervals in Federally Qualified Health Centers

Factors Associated with a Lack of Pap Smear Utilization in Women Exposed In Utero to Diethylstilbestrol

Contact Info

Product

Resources

About