Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA.
Office of Community Outreach, Engagement, and Equity, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA.
Cancer. 2023 Sep 1;129(17):2671-2684. doi: 10.1002/cncr.34838. Epub 2023 May 23.
The 2019 American Society for Colposcopy and Cervical Pathology (ASCCP) risk-based management consensus guidelines are the most recent national guidelines for the management of abnormal cervical cancer screening tests. These guidelines benefit patients by concentrating testing and treatment in those at highest cervical cancer risk. Adoption of guidelines often occurs slowly, with few studies examining the factors associated with guideline-adherent management of abnormal results.
To elucidate the factors associated with the use of the 2019 ASCCP guidelines among clinicians who perform cervical cancer screening, physicians and advanced practice professionals who perform cervical cancer screening were cross-sectionally surveyed. Clinicians responded to screening vignettes with differing recommendations for management between the 2019 and prior management guidelines. Screening vignette 1 involved reduction of invasive testing on a low-risk patient; screening vignette 2 involved increased surveillance testing on a high-risk patient. Binomial logistic regression models determined the factors associated with the use of the 2019 guidelines.
A total of 1251 clinicians participated from across the United States. For screening vignettes 1 and 2, guideline-adherent responses were given by 28% and 36% of participants, respectively. Management recommendations differed by specialty and were incorrect in different situations: there was inappropriate invasive testing by obstetrics and gynecology physicians (vignette 1) and inappropriate discontinuation of screening by family and internal medicine physicians (vignette 2). Regardless of their chosen response, over half erroneously believed they were guideline adherent.
Many clinicians who believe they are following appropriate guidelines may not realize their management strategy is inconsistent with the 2019 guidelines. Education initiatives tailored to clinician specialty could address the understanding of current guidelines, encourage the use of updated guidelines, maximize patient benefits, and minimize harms.
The 2019 American Society for Colposcopy and Cervical Pathology risk-based management consensus guidelines are the most recent national guidelines for abnormal cervical cancer screening test management. We surveyed over 1200 obstetrics and gynecology (OB/GYN), family medicine, and internal medicine physicians and advanced practice providers about their screening and abnormal results follow-up practices in relation to guidelines. Few clinicians are following the 2019 guidelines. Management recommendations differed by clinician specialty and were incorrect in different situations: there was inappropriate invasive testing by OB/GYN physicians and inappropriate screening discontinuation by family and internal medicine physicians. Education tailored by clinician specialty could address the understanding of current guidelines, encourage the use of updated guidelines, maximize patient benefits, and minimize harms.
2019 年美国阴道镜和宫颈病理学会(ASCCP)基于风险的管理共识指南是目前针对异常宫颈癌筛查检测管理的最新国家指南。这些指南通过将检测和治疗集中在宫颈癌风险最高的人群中,使患者受益。指南的采用通常进展缓慢,很少有研究检查与异常结果的指南一致管理相关的因素。
为了阐明在进行宫颈癌筛查的临床医生中使用 2019 年 ASCCP 指南的相关因素,对进行宫颈癌筛查的医生和高级执业专业人员进行了横断面调查。临床医生根据 2019 年和之前的管理指南对不同的管理建议进行了筛查案例分析。筛查案例 1 涉及对低危患者减少侵入性检测;筛查案例 2 涉及对高危患者增加监测检测。二项逻辑回归模型确定了与使用 2019 年指南相关的因素。
来自美国各地的共 1251 名临床医生参与了这项研究。对于筛查案例 1 和 2,分别有 28%和 36%的参与者给出了符合指南的回答。管理建议因专业而异,在不同情况下是不正确的:妇产科医生进行了不适当的侵入性检测(案例 1),家庭和内科医生不当停止了筛查(案例 2)。无论他们选择哪种回答,超过一半的人错误地认为他们符合指南。
许多认为自己遵循了适当指南的临床医生可能没有意识到他们的管理策略与 2019 年指南不一致。针对临床医生专业的教育计划可以解决对当前指南的理解,鼓励使用更新的指南,最大限度地提高患者的受益,最大限度地减少危害。