Colling Ana Machado, Saunders Tessa, Creagh Nicola, Ashfaq Maleeha, Brotherton Julia, Nightingale Claire
Evaluation and Implementation Science Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
Health Expect. 2025 Aug;28(4):e70397. doi: 10.1111/hex.70397.
Australia's human papillomavirus (HPV)-based National Cervical Screening Program guidelines state that anyone eligible for screening should be offered a choice of using self-collection or clinician collection for initial screening.
To explore the awareness and experiences of women and people with a cervix who have been screened since this choice became available in July 2022.
Semi-structured online or telephone interviews were conducted between February and May 2024 with 43 Victorian women and people with a cervix, aged 25-74 years. All participants self-reported completing a cervical screen within 12 months of our study. Interview data were recorded, transcribed verbatim and thematically analysed before being mapped to The Ottawa Decision Support Framework. Self-reported screening history was confirmed with de-identified data from the National Cancer Screening Register (NCSR) Victorian Raw Data Extract (November 2024).
Fewer than half (19, 44%) of those interviewed were given a choice at their most recent screen, with variation in how options were presented by healthcare providers. Participants felt they lacked awareness and knowledge to feel confident in their options. Most participants viewed having a choice as important and, even if they did not prefer self-collection for themselves, noted benefits for others. Some felt disappointed or angry about not having a choice, while others were happy to defer to their doctor. Relationships with, and the views of, healthcare providers strongly influenced decision-making. Participants reflected on potential advantages of self-collection if it could reduce the cost of appointments and be accessed in more flexible ways. Among the 38 participants who consented to screening history verification, the self-reported data showed reasonable accuracy (67%) against the NCSR.
Despite a clear policy directive for practitioners to offer a choice to all eligible individuals, many recent screeners were not offered the choice or lacked the knowledge, confidence and decision supports needed to make an informed choice. The choice of screening method appears strongly influenced by if, and how, options are presented by healthcare providers. A range of strategies are needed to ensure screeners feel empowered, supported and informed to make and carry out a real choice.
Members of the public were involved in interviews. Findings were summarised and disseminated via a short report. A consumer advisory panel provided feedback on the content, readability and length of all patient-facing resources.
澳大利亚基于人乳头瘤病毒（HPV）的国家宫颈癌筛查计划指南规定，任何符合筛查条件的人在初次筛查时都应可以选择自行采集或由医护人员采集样本。
探讨自2022年7月有此选择以来接受过筛查的女性及有子宫颈的人群的认知和经历。
2024年2月至5月，对43名年龄在25至74岁之间的维多利亚州女性及有子宫颈的人群进行了半结构化在线或电话访谈。所有参与者均自我报告在我们研究的12个月内完成了宫颈癌筛查。访谈数据被记录、逐字转录并进行主题分析，然后映射到渥太华决策支持框架。通过国家癌症筛查登记处（NCSR）维多利亚原始数据提取物（2024年11月）中的去识别数据确认自我报告的筛查历史。
不到一半（19人，44%）的受访者在最近一次筛查时获得了选择机会，医护人员介绍选择的方式存在差异。参与者觉得自己缺乏相关认知和知识，无法对自己的选择充满信心。大多数参与者认为有选择很重要，即使他们自己不倾向于自行采集，也指出了对其他人的好处。一些人因没有选择而感到失望或愤怒，而另一些人则乐于听从医生建议。与医护人员的关系以及他们的观点对决策有很大影响。参与者思考了自行采集的潜在优势，如果它可以降低预约成本并以更灵活的方式进行。在同意筛查历史验证的38名参与者中，自我报告的数据与NCSR相比显示出合理的准确性（67%）。
尽管有明确的政策指示要求从业者为所有符合条件的个体提供选择，但许多近期接受筛查的人没有获得选择机会，或者缺乏做出明智选择所需的知识、信心和决策支持。筛查方法的选择似乎受到医护人员是否以及如何介绍选择的强烈影响。需要一系列策略来确保筛查者感到有能力、得到支持并了解情况，从而做出并执行真正的选择。
公众成员参与了访谈。研究结果通过一份简短报告进行了总结和传播。一个消费者咨询小组对所有面向患者的资源的内容、可读性和长度提供了反馈。
