Quality in Primary Care Open Access

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Predictors of patient comfort and adherence with less frequent cervical cancer screening

Kurt B Angstman, Kathy L MacLaughlin, Priscilla M Flynn, Jessica R Schmitt, Amy L Weaver, Lynne T Shuster

Background The Papanicolaou (Pap) test is an effective, well-accepted screening tool that has led to a decrease in cervical cancer incidence and mortality. Updated evidence-based cervical cancer screening guidelines support less frequent testing in low-risk patients but have met resistance from providers and patients. AimsTo assess patient knowledge about cervical cancer screening and attitudes toward recommendations for less frequent testing. MethodsA hard copy of an eight-question survey was distributed to 389 women aged 30–64 years at two primary care clinics in Rochester, Minnesota, over a six-week period. ResultsThe survey response rate was 86.8%.Of the 280 women who responded to a survey question about the cause of cervical cancer, 212 (75.7%) identified human papillomavirus (HPV) as the cause. Multivariable logistic regression analysis showed that this knowledge was not associated with feeling comfortable with a recommendation for less frequent testing or with support for less frequent testing. The only significant predictor of patient comfort and adherence with a two- to three-year Pap testing interval was the patient’s belief about whether a Pap test was needed annually or every two or three years. Conclusions Patient belief about Pap testing frequency was the strongest predictor of attitude toward less frequent Pap testing and was not based on knowledge of HPV. Future studies should explore why some patients continue to expect annual testing and identify interventions to help providers elicit and change patients’ expectations about cervical cancer screening.

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