Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia.
Department of Family Medicine. Pontificia, Universidad Católica de Chile, Santiago, Chile.
BMC Cancer. 2023 Jul 12;23(1):653. doi: 10.1186/s12885-023-11082-z.
Cervical cancer is a preventable and treatable form of cancer yet continues to be the fourth most common cancer among women globally. Primary care is the first point of contact most patients have with health services and is where most cancer prevention and early detection occur. Inadequate follow-up of abnormal test results for cervical abnormalities in primary care can lead to suboptimal patient outcomes including higher mortality and decreased quality of life.
To explore the magnitude of and factors associated with, inadequate follow-up of test results for cervical abnormalities in primary and ambulatory care.
MEDLINE, Embase, Cochrane Library and CINAHL were searched for peer-reviewed literature from 2000-2022, excluding case-studies, grey literature, and systematic reviews. Studies were included if they reported on patients aged ≥ 18 years with no previous cancer diagnosis, in a primary care/ambulatory setting. Risk of bias was assessed using the Joanna Briggs Institute Critical appraisal checklists, appropriate to the study design. A segregated methodology was used to perform a narrative synthesis, maintaining the distinction between quantitative and qualitative research.
We included 27 publications reporting on 26 studies in our review; all were conducted in high-income countries. They included 265,041 participants from a variety of ambulatory settings such as family medicine, primary care, women's services, and colposcopy clinics. Rates of inadequate follow-up ranged from 4 to 75%. Studies reported 41 different factors associated with inadequate follow-up. Personal factors associated with inadequate follow-up included younger age, lower education, and socioeconomic status. Psychological factors were reported by only 3/26 studies and 2/3 found no significant association. System protective factors included the presence of a regular primary care provider and direct notification of abnormal test results.
This review describes inadequate follow-up of abnormal cervical abnormalities in primary care. Prevalence varied and the evidence about causal factors is unclear. Most interventions evaluated were effective in decreasing inadequate follow-up. Examples of effective interventions were appointment reminders via telephone, direct notification of laboratory results, and HPV self-sampling. Even though rates of cervical cancer have decreased over the years, there is a lack of information on factors affecting follow-up in primary care and ambulatory settings, particularly in low and middle-income countries. This information is crucial if we are to achieve WHO's interim targets by 2030, and hope to avert 62 million cervical cancer deaths by 2120.
PROSPERO ID CRD42021250136.
宫颈癌是一种可预防和可治疗的癌症，但仍是全球女性中第四常见的癌症。初级保健是大多数患者与卫生服务机构的首次接触点，也是大多数癌症预防和早期发现的地方。初级保健中对宫颈异常的异常检测结果进行不充分的随访可能导致患者结局不理想，包括死亡率较高和生活质量下降。
探讨初级保健和门诊护理中宫颈异常检测结果不充分随访的程度和相关因素。
从 2000 年至 2022 年，在 MEDLINE、Embase、Cochrane 图书馆和 CINAHL 中搜索同行评议文献，排除病例研究、灰色文献和系统评价。如果研究报告了年龄≥18 岁、无既往癌症诊断、在初级保健/门诊环境中的患者，则纳入研究。使用 Joanna Briggs 研究所的批判性评估检查表评估偏倚风险，适用于研究设计。使用单独的方法进行叙述性综合，保持定量和定性研究之间的区别。
我们的综述纳入了 27 篇报告 26 项研究的文献；所有研究均在高收入国家进行。它们包括来自各种门诊环境（如家庭医学、初级保健、妇女服务和阴道镜诊所）的 265041 名参与者。不充分随访的比例从 4%到 75%不等。研究报告了 41 个与不充分随访相关的不同因素。与不充分随访相关的个人因素包括年龄较小、教育程度较低和社会经济地位较低。只有 3/26 项研究报告了心理因素，其中 2/3 项研究未发现显著关联。系统保护因素包括有固定的初级保健提供者和直接通知异常检测结果。
本综述描述了初级保健中宫颈异常不充分随访的情况。患病率各不相同，关于因果因素的证据尚不清楚。评估的大多数干预措施都能有效减少不充分随访。有效的干预措施示例包括通过电话进行预约提醒、直接通知实验室结果和 HPV 自我采样。尽管近年来宫颈癌的发病率有所下降，但在初级保健和门诊环境中，特别是在低收入和中等收入国家，关于影响随访的因素的信息仍然缺乏。如果我们要实现世卫组织到 2030 年的临时目标，并希望在 2120 年避免 6200 万例宫颈癌死亡，那么这些信息至关重要。
PROSPERO ID CRD42021250136。
