Using communication to manage uncertainty about cervical cancer screening guideline adherence among Appalachian women

Abstract

Changes to the United States Preventive Services Task Force (USPSTF) recommendations for cervical cancer preventive services have led to patient confusion, especially in medically underserved populations. We investigated how patient uncertainty concerning cervical cancer screening guidelines is appraised and managed through communication with healthcare providers by conducting in-depth, face-to-face interviews with 24 adult women between the ages of 24 and 65 (m = 41, SD = 14) living in Appalachia Kentucky. In general, participants expressed a high degree of uncertainty about the updated cervical cancer screening guidelines and appraised this uncertainty as both a danger and an opportunity. Communication with healthcare providers served both to exacerbate and to mitigate patient uncertainty. The study identifies how health care providers may use the change in USPSTF guidelines as a ‘teachable moment’ to productively counsel patients on the importance of timely screening, the typical progression of certain types of high-risk HPV infection to cervical cancer, and the importance of follow-up care.

Factors Influencing Pap Screening Use Among African Immigrant Women

“…However, the impact is yet to be determined among sub-Saharan African immigrants, some of whom may not qualify for coverage based on immigration status. In Kentucky, free and low-cost screening is available to all women through the Kentucky Women’s Cancer Screening program, funded by the Centers for Disease Control and Prevention’s Breast and Cervical Cancer Early Detection Program (Cohen et al, 2016). Underinsured sub-Saharan African immigrant women may benefit from low-cost screening programs such as these as well as navigation assistance to connect them with the appropriate programs.…”

Place, Power, and Premature Mortality: A Rapid Scoping Review on the Health of Women in Appalachia

“…Overall, articles focused on cancer disparities (49.4%) with a particular focus on cervical cancer (27.2%). 26 -46 Many of the remaining articles focused on cancer-related risk factors, such as Human Papillomavirus (HPV; 16.0%), 41,47 -54 smoking (16.0%), 55 -64 or prenatal or gynecologic care (23.5%). 60 -62,64 -80 See Figure 2 for a summary of the reviewed health topics divided by decade of publication; these topics are not mutually exclusive, as 1 article could discuss multiple health topics.…”

“…Study findings identified individual-level factors for health outcomes and behaviors including: medical knowledge (eg, causes of disease, 26 uncertainty of guidelines, 27 misinformation about disease 38,49 ), attitudes/perceptions (eg, need for privacy; 37,38,102 -104 lack of perceived need; 32,36,103,104 emotional reaction, including fear, worry, and embarrassment, 14,28,36,37,51,104 lack of control over disease 51 ) and skills (eg, ability to manage and negotiate uncertainty 27 ). In rural areas, some studies suggested that the desire to avoid having an acquaintance involved in health-related decision-making increases body discomfort and worry of stigma, supporting the elevated need for privacy.…”

Role of the Internet in Care Initiation by People Living With HIV

“…Information online helped participants see that a solution was available to them and helped them make decisions regarding their care and treatment. The information was also used to advocate for themselves in discussions with providers and in making decisions regarding specific treatment options (Brashers, Haas, & Neidig, 1999;Brashers et al, 2000). Participants were seen to enact three self-advocacy strategies previously described: (i) increasing their health literacy, (ii) increasing their interpersonal assertiveness with providers, and (iii) increasing their willingness to question providers' recommendations as part of becoming more participative in their health care decision-making (Brashers et al, 1999).…”