Adler David, Abar Beau, Wood Nancy, Bonham Adrienne
Department of Emergency Medicine, University of Rochester, Rochester, New York.
Department of Obstetrics & Gynecology, University of Rochester, Rochester, New York.
J Emerg Med. 2019 Dec;57(6):836-843. doi: 10.1016/j.jemermed.2019.07.021. Epub 2019 Oct 5.
Emergency departments (EDs) have the potential to promote critical public and preventive health interventions. Cervical cancer (CC) screening has been a cornerstone of preventive health efforts for decades. Approximately 20% of U.S. women are not adherent with CC screening guidelines-considerably below the U.S. Federal Government's target. ED patients are disproportionately nonadherent with CC screening guidelines. The ED, therefore, is an optimal setting to target women with an intervention that promotes CC screening.
To assess the feasibility and potential efficacy of an intervention, grounded in behavioral change theory, to promote uptake of CC screening among ED patients.
Design: Randomized clinical trial pilot study; Patients: Women aged 21-65 years that were identified in the ED to be nonadherent with CC screening recommendations; Setting: Single center urban academic ED.
Among enrolled participants, 355 (79%) were determined to be adherent with screening recommendations and 95 (21%) were determined to be either nonadherent or have uncertain adherence. Among the nonadherent/uncertain group, 47 were randomized to the control condition (referral only) and 48 were randomized to the intervention condition. Thirty-six percent of participants in the control condition received or scheduled screening during the follow-up period. In the intervention condition, 43% received or scheduled screening during the follow-up period-a 19% relative improvement over the control condition.
This pilot study demonstrates feasibility and preliminary efficacy of a behavioral intervention to increase uptake of CC screening among ED patients.
急诊科有潜力促进关键的公共卫生和预防健康干预措施。几十年来，宫颈癌（CC）筛查一直是预防健康工作的基石。约20%的美国女性未遵循CC筛查指南，远低于美国联邦政府的目标。急诊科患者不遵循CC筛查指南的比例过高。因此，急诊科是针对女性进行促进CC筛查干预的理想场所。
评估基于行为改变理论的干预措施在促进急诊科患者接受CC筛查方面的可行性和潜在效果。
设计：随机临床试验试点研究；患者：在急诊科被确定未遵循CC筛查建议的21至65岁女性；地点：单中心城市学术急诊科。
在纳入的参与者中，355人（79%）被确定遵循筛查建议，95人（21%）被确定为不遵循或依从性不确定。在不遵循/不确定组中，47人被随机分配到对照条件（仅转诊），48人被随机分配到干预条件。在随访期间，对照条件下36%的参与者接受或安排了筛查。在干预条件下，43%的参与者在随访期间接受或安排了筛查，比对照条件相对提高了19%。
这项试点研究证明了一种行为干预措施在增加急诊科患者接受CC筛查方面的可行性和初步效果。
