MacLaughlin Kathy L, Jacobson Robert M, St Sauver Jennifer L, Jenkins Gregory D, Fan Chun, Finney Rutten Lila J
Department of Family Medicine, Rochester, Minnesota, USA.
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota, USA.
Womens Health Rep (New Rochelle). 2022 Jan 7;3(1):10-19. doi: 10.1089/whr.2021.0074. eCollection 2022.
Cervical cancer screening has shifted toward human papillomavirus (HPV)-based testing, but uptake of primary HPV screening in the United States is unknown and previous studies highlight delays in clinician adoption of guideline updates. We conducted a cross-sectional electronic survey of primary care clinicians ( = 252; response rate = 30.9%) assessing awareness and support of primary HPV screening. We assessed factors for association with past use of HPV testing and support of clinician- and patient-collected HPV testing individually using Fisher's exact test and jointly using Firth's logistic regression. Most clinicians (79%) were familiar with one or more primary HPV screening guidelines. Support for clinician-collected (89%) and patient-collected (82%) HPV testing was high, but only 34.5% reported prior use. Guideline familiarity was positively associated with HPV testing in practice ( = 0.0001). Support of clinician-collected testing was positively associated with more years in practice ( = 0.03), internal (vs. family) medicine specialty ( = 0.03), and guideline familiarity ( ≤ 0.0001). Male clinicians more frequently supported patient collection for patients overdue for screening ( = 0.013). Physicians more frequently than advanced practice providers (APPs) supported patient collection for screening-adherent women ( = 0.021). Multivariable analysis showed those unfamiliar with guidelines were less likely to have used HPV testing [odds ratio, OR: 0.10 (0.03-0.32)] or to support clinician-collected HPV testing [OR: 0.16 (0.07-0.37)]. APPs were less likely than physicians to support patient-collected HPV testing among screening-adherent women [OR: 0.42 (0.20-0.87)]. We observed high levels of guideline awareness and clinician support for primary HPV testing, despite relatively low use. This merits further exploration to inform future interventions to increase uptake.
宫颈癌筛查已转向基于人乳头瘤病毒(HPV)的检测,但美国初级HPV筛查的接受情况尚不清楚,且以往研究强调临床医生在采用指南更新方面存在延迟。我们对初级保健临床医生进行了一项横断面电子调查(n = 252;回复率 = 30.9%),评估对初级HPV筛查的知晓度和支持度。我们分别使用Fisher精确检验以及联合使用Firth逻辑回归评估与过去HPV检测使用情况以及对临床医生采集和患者自采HPV检测的支持度相关的因素。大多数临床医生(79%)熟悉一种或多种初级HPV筛查指南。对临床医生采集(89%)和患者自采(82%)HPV检测的支持度较高,但只有34.5%报告曾使用过。指南知晓度与实际HPV检测呈正相关(P = 0.0001)。对临床医生采集检测的支持度与执业年限更长(P = 0.03)、内科(相对于家庭医学)专科(P = 0.03)以及指南知晓度(P≤0.0001)呈正相关。男性临床医生更频繁地支持为筛查逾期患者进行患者自采(P = 0.013)。与高级实践提供者(APP)相比,医生更频繁地支持为坚持筛查的女性进行患者自采(P = 0.021)。多变量分析显示,不熟悉指南的人使用HPV检测的可能性较小[比值比,OR:0.10(0.03 - 0.32)],或支持临床医生采集HPV检测的可能性较小[OR:0.16(0.07 - 0.37)]。在坚持筛查的女性中,APP支持患者自采HPV检测的可能性低于医生[OR:0.42(0.20 - 0.87)]。尽管使用率相对较低,但我们观察到对初级HPV检测的指南知晓度和临床医生支持度较高。这值得进一步探索,以为未来提高接受率的干预措施提供信息。