Implementing cervical cancer screening guidelines at a community health center: a quality improvement project

Abstract

Background: Cervical cancer remains a significant health concern worldwide, affecting over 500,000 individuals. Despite great progress towards its elimination, many healthcare providers have substantial knowledge gaps and are unaware of and do not follow current screening guidelines. Purpose: The purpose of this quality improvement project was to decrease the incidence of preventable cervical cancer among Wahiawā Center for Community Health patients by increasing the rate of guideline-adherent screening. To achieve this, the project had two objectives: (1) increase awareness and understanding of cervical cancer screening and management guidelines among providers and support staff (i.e., medical assistants and patient service representatives) and (2) increase patient understanding of pelvic exams, cervical cytology, human papillomavirus testing, and human papillomavirus’ link to cervical cancer. Methods: A multi-pronged approach was employed, consisting of two tailored educational presentations, a “cheat sheet,” a patient education handout, and a demonstration of the American Society for Colposcopy and Cervical Pathology management website. Post-tests were administered to providers and support staff immediately after participation in the educational presentations and eight weeks later. Results: The educational presentations had twenty-eight participants: three family medicine providers, two pediatric providers, three behavioral health providers, 11 medical assistants, and nine patient service representatives. Of the three family medicine providers, two completed the immediate post-test and two completed the eight-week post-test (response rate of 67%). Of the 20 support staff, seven completed the immediate post-test and nine completed the eight-week post-test (response rate of 35% and 45%, respectively). Providers and support staff showed high accuracy immediately after participation in the educational presentations and high knowledge retention after eight weeks. However, some knowledge loss was observed, particularly regarding cervical cancer screening intervals. Initially, 100% of providers and support staff selected the correct co-test interval. After eight weeks, only 50% of providers and 67% of support staff selected the correct co-test interval, with the remaining respondents selecting an interval that is too short. Both groups demonstrated difficulty correctly identifying appropriate patients to exit from routine screening. In addition, the providers had room for improvement on the questions assessing the management of abnormal screening results. Patient understanding was indirectly assessed through the provider and support staff post-tests, which indicated that the patient education handout was effective. Conclusion: The educational intervention was effective in achieving the project's objectives (i.e., increasing awareness and understanding of cervical cancer screening and management guidelines among providers and support staff, and increasing patient understanding of pelvic exams, cervical cytology, human papillomavirus testing, and human papillomavirus’ link to cervical cancer). Due to the project's time constraint, the goal of decreasing the incidence of cervical cancer among Wahiawā Center for Community Health patients was not assessed. Recommendations: Given the long natural history of cervical cancer, long-term surveillance of clinic data is needed to assess the project’s impact on cervical cancer incidence. As the rate of guideline-adherent cervical cancer screening increases, it is anticipated that the incidence of preventable cervical cancer will decrease. To improve retention of screening interval knowledge, providers and support staff may benefit from intermittent refresher training and review of the “cheat sheet.” These findings highlight screening exiting criteria and management of abnormal screening results as potential directions for future training.