Boone Emily, Lewis LaVonna, Karp Michael
1 Sol Price School of Public Policy, University of Southern California , Los Angeles, California.
2 Department of General Internal Medicine, Keck School of Medicine, University of Southern California , Los Angeles, California.
J Womens Health (Larchmt). 2016 Mar;25(3):255-62. doi: 10.1089/jwh.2015.5326. Epub 2015 Nov 5.
In 2012, new cervical cancer screening guidelines were published by three widely recognized entities which advocate delayed onset of testing, fewer screenings, selective use of human papilloma virus co-testing, and no further screening in women over age 65 years. Early observations report that these recommendations are not being followed and overscreening is common. This study seeks to understand why primary care providers might not adhere to these new 'best practice' health policy protocols.
A total of 4,909 randomly selected primary care providers (physicians, nurse practitioners, and physician assistants) practicing in California were mailed a study questionnaire. Participants were asked if they consider current published screening guidelines to be authoritative, reliable, and/or clinically appropriate. Clinical vignettes captured individual provider beliefs on timing and method of cervical cancer screening in women within the four key age groups embedded in current screening guidelines.
Of the 4,909 surveys mailed, 1,268 (25.8%) qualified responses were received. Fundamentally, 35.0% of all primary care providers do not believe current guidelines are clinically appropriate, with 58.6% of obstetrician/gynecologist physicians having this same skepticism. Even among those who affirmatively believe current guidelines are authoritative, reliable, and clinically appropriate, only 15.3% recommend screening intervals and methodology of testing in women of four differing ages consistent with that of current policy guidelines.
Among the primary care providers surveyed, distrust and confusion likely limit adherence to current evidence-based cervical cancer screening health policy recommendations, and contribute to the current high rates of overscreening that have been observed.
2012年，三个广受认可的机构发布了新的宫颈癌筛查指南，提倡推迟开始筛查、减少筛查次数、选择性使用人乳头瘤病毒联合检测，以及65岁以上女性不再进行进一步筛查。早期观察报告称，这些建议未得到遵循，过度筛查很常见。本研究旨在了解初级保健提供者可能不遵守这些新的“最佳实践”健康政策方案的原因。
向在加利福尼亚州执业的4909名随机选择的初级保健提供者（医生、执业护士和医师助理）邮寄了一份研究问卷。参与者被问及他们是否认为当前发布的筛查指南具有权威性、可靠性和/或临床适用性。临床案例记录了个体提供者对当前筛查指南中四个关键年龄组女性宫颈癌筛查时间和方法的看法。
在邮寄的4909份调查问卷中，收到了1268份（25.8%）合格回复。从根本上说，35.0%的初级保健提供者认为当前指南在临床上不合适，58.6%的妇产科医生也有同样的怀疑态度。即使在那些肯定认为当前指南具有权威性、可靠性和临床适用性的人中，只有15.3%的人针对四个不同年龄女性的筛查间隔和检测方法的建议与当前政策指南一致。
在接受调查的初级保健提供者中，不信任和困惑可能会限制对当前基于证据的宫颈癌筛查健康政策建议的遵守，并导致目前观察到的高过度筛查率。
