NORMANDIE UNIV, UNICAEN, INSERM, ANTICIPE, 14000, Caen, France.
NORMANDIE UNIV, UNICAEN, UFR Sante, Department of General Practice, 14000, Caen, France.
BMC Health Serv Res. 2020 Jul 27;20(1):693. doi: 10.1186/s12913-020-05479-w.
Cervical cancer screening is effective in reducing mortality due to uterine cervical cancer (UCC). However, inequalities in participation in UCC screening exist, especially according to age and social status. Considering the current situation in France regarding the ongoing organized UCC screening campaign, we aimed to assess general practitioners' (GPs) and gynaecologists' preferences for actions designed to reduce screening inequalities.
French physicians' preferences to UCC screening modalities was assessed using a discrete choice experiment. A national cross-sectional questionnaire was sent between September and October 2014 to 500 randomly selected physicians, and numerically to all targeted physicians working in the French region Midi-Pyrénées. Practitioners were offered 11 binary choices of organized screening scenarios in order to reduce inequalities in UCC screening participation. Each scenario was based on five attributes corresponding to five ways to enhance participation in UCC screening while reducing screening inequalities.
Among the 123 respondents included, practitioners voted for additional interventions targeting non-screened women overall (p < 0.05), including centralized invitations sent from a central authority and involving the mentioned attending physician, or providing attending physicians with the lists of unscreened women among their patients. However, they rejected the specific targeting of women over 50 years old (p < 0.01) or living in deprived areas (p < 0.05). Only GPs were in favour of allowing nurses to perform Pap smears, but both GPs and gynaecologists rejected self-collected oncogenic papillomavirus testing.
French practitioners tended to value the traditional principle of universalism. As well as rejecting self-collected oncogenic papillomavirus testing, their reluctance to support the principle of proportionate universalism relying on additional interventions addressing differences in socioeconomic status needs further evaluation. As these two concepts have already been recommended as secondary development leads for the French national organized screening campaign currently being implemented, the adherence of practitioners and the adaptation of these concepts are necessary conditions for reducing inequalities in health care.
宫颈癌筛查在降低宫颈癌死亡率方面具有显著效果。然而，宫颈癌筛查的参与度存在不平等现象，尤其是在年龄和社会地位方面。考虑到法国当前正在开展的有组织宫颈癌筛查活动的现状，我们旨在评估全科医生和妇科医生对旨在减少筛查不平等的措施的偏好。
使用离散选择实验评估法国医生对宫颈癌筛查方式的偏好。2014 年 9 月至 10 月，向 500 名随机选择的医生和所有在法国米迪-庇里牛斯地区工作的目标医生发送了一份全国性的横断面问卷。医生们提供了 11 种有组织的筛查方案选择，以减少宫颈癌筛查参与度的不平等。每个方案都是基于五个属性，对应于五种提高宫颈癌筛查参与度同时减少筛查不平等的方法。
在 123 名受访者中，医生总体上投票支持针对未筛查女性的额外干预措施（p<0.05），包括来自中央权威机构的集中邀请，并涉及到提到的主治医生，或向主治医生提供其患者中未筛查女性的名单。然而，他们拒绝针对 50 岁以上或生活在贫困地区的女性进行特定目标定位（p<0.01）。只有全科医生赞成允许护士进行巴氏涂片检查，但全科医生和妇科医生都拒绝自我采集的致癌性人乳头瘤病毒检测。
法国医生倾向于重视普遍性原则。除了拒绝自我采集的致癌性人乳头瘤病毒检测外，他们不愿意支持基于解决社会经济地位差异的额外干预措施的相称普遍性原则，这需要进一步评估。由于这两个概念已经被推荐为当前正在实施的法国国家有组织筛查活动的次要发展线索，医生的遵守和这些概念的适应是减少医疗保健不平等的必要条件。
