Pre-graduate Medical Student
Amalie Løvkiel
Department of Gynaecology and Obstetrics, Odense University Hospital
| Project management | ||
| Project status | Open | |
| Data collection dates | ||
| Start | 01.02.2024 | |
| End | 31.01.2025 | |
Increasing Cervical Cancer Screening Participation: A Cluster-Randomized Quality Study at the Department of Gynaecology
Short summary
Since 2007, Danish women aged 23-64 have been offered cervical cancer screening (CCS), aiming to catch and treat changes before they develop into cancer. Despite this, only 60.5% participate within a year of invitation. This study investigates if offering CCS in outpatient Gynaecology can boost participation, especially among under-screened women. A three-arm cluster-randomized design will compare intervention and control groups, focusing on participation rates and attitudes to the interventions
Rationale
BACKGROUND Since 2007, all Danish women, between the ages of 23-64, have been offered to participate in a cervical cancer screening (CCS). The aim of the screening is to reduce the mortality rate by catching and treating the women with epithelial changes before it might evolve into cervical cancer. The evolvement from epithelial changes to cancer can happen over the course of a decade, while some changes may never develop. In 2021, 275 new incidences of cervical cancer was reported in Denmark. That same year the national CCS program was modified, which means age and birth date has an impact on whether you are offered; primary HPV-test or cytology test, 10 or 12 screening test, 3 or 5 year intervals. Even though it's estimated that the relative reduction in lifetime risk by participating in the CCS is 71% on average for the population, only 60,5% of the Danish women choose to participate in the screening within one year of receiving the invitation. The majority of cervical cancer is caused by human papillomavirus (HPV), transmitted during intimate contact with an infected individual. Due to this, the National board of Health introduced the HPV-vaccination in 2009 as part of the national vaccination program. The vaccine is offered to girls around the age of 12-17 and since 2019 it has been available for boys too. Using condom or femidom are not enough to prevent cervical cancer, so by vaccinating the children before their sexual debut, it is possible to prevent future cervical cancer incidence. According to DKLS-rapport 2022, 60,5% of the women invited to the screening, chose to participate within a year versus around 83% participating in the mammography screening, out of all invited. Why fewer women choose not to follow their cervical cancer screening plan has been examined, and the National board of Health suggest that barriers included are: • Practical conditions, such as not finding the time to book or go to an appointment • Not feeling informed or comfortable with their general practitioner conducting the examination • Feeling emotional and physical discomfort during the gynecologic exam • Variations in personal risk assessment for developing cervical cancer • Incomplete or incorrect knowledge of screening Studies confronting some of the barriers already exist (e.g. implementing a self-kit testing in the screening program), but to our knowledge, researching whether offering CCS in the outpatient Gynaecology and Obstetrics department will increase the partition rate, has not yet been explored. Earlier studies describe the groups of women with the lowest CCS participation as women with high age, limited/no contact with general practitioner, not being married, low socio-economic status, ethnic minorities and women with functional impairment. By offering CCS for women attending the outpatient department, it is possible to research, which women will benefit from the offer, if the intervention target those specific groups and if those women's' description fits those of 'never-screened' or 'under-screened' individuals. This means the intervention also could lower social inequality in health care services including prevention. AIM The aim of this study is to explore whether interventions at a department of Gynaecology and Obstetrics can increase the number of women participating in the CSS. Focus will in particular be on the under-screened/never-screened women, as they are known to benefit the most from screening interventions, as we may diagnose the cervical cancer early or even as a precursor. By sending a structured questionnaire to the women, regarding their attitude towards being offered screening in relation to visiting the department for their referral diagnosis, we can explore if they prefer being offered a test by healthcare professionals or asking for one themselves.
Description of the cohort
The project is a three-arm cluster randomized quality study with interventions conducted over a 4 month period. The study consists of two intervention groups, A and B, with women referred to the outpatient clinic in Odense, as well as one control group with women referred to Svendborg. Intervention group A involves women receiving a summons letter with an attached file encouraging them to actively request CCS during their visit. The file contains a link to the declaration of consent made in REDCap, regarding participation in this study. Intervention group B will be offered screening by their doctor or nurse in the outpatient clinic. They will be asked to fill out the declaration of consent from a QR-code in the outpatient clinic. Control group C consist of patients referred to the outpatient clinic in Svendborg. The data from their patient journals will be accessed retrospectively. The declaration states that participating includes giving us consent to use personal information from their EPJ SYD journals, as well as permitting us to send them a questionnaire after their visit at the department of Gynaecology and Obstetrics at Odense University Hospital (OUH). The structured questionnaire is containing questions regarding sociodemographic, risk factor, women's choice to/not to follow their CCS program and their opinion about the interventions. The department of Gynaecology and Obstetrics OUH is situated at two different location sites, which is ground for the division of the control and intervention groups. The two intervention groups are divided based on date of appointment at the department. The allocation is naturally formed based on the first referment to the department of Gynaecology and Obstetrics OUH. The non-cancer patients are distributed based on their referral diagnosis, which means nothing insinuates a difference regarding screening. But this will be examined as part of the study, as will the participation percentage for the total number of patients. The study population will comprise of women aged 23-64 years, who have an appointment at either urogynecology or general gynecology outpatient department in Odense. The women included has to be at least >6 months overdue with their CCS according to the National board of Health's recommendations. Pregnant women, women with prior hysterectomy and women with prior cervical cancer are excluded from the study.
Data and biological material
The data assembled comes from the patients journal and survey answers. From the patient journal; age, reference diagnosis, reference diagnosis, hysterectomy or former gynecologic cancer, screening history, previous cervical dysplasia and treatment. The data collected from the survey will be roamed for potential patterns. The questions in the survey include; sociodemographic variables, choice of contraception, number of sexual partners, smoking status, HPV-vaccination status, recall of test history, thoughts on the two interventions and choice of (not) participating in the CCS program.
Publications associated with the project