Cervical cancer screening is an important component of women’s health care. Most adult women are familiar with the conventional screening modality, the Pap test, which has successfully reduced the burden of cervical cancer in industrialized countries. However, the Pap test has limited accuracy and can miss a progressing disease. Advancement in knowledge and technology has led to changes in national recommendations to focus on the testing of high-risk human papillomavirus (HPV) infection, which can cause cervical cancer. Screening with primary HPV testing detects more diseases compared with the Pap test alone or co-testing and requires fewer tests. However, despite the advantages of primary HPV screening over conventional approaches, the switch to primary HPV screening is limited in the United States. The scientific literature reports both provider- and patient-level barriers, which include lack of knowledge, resistance, and attachment to the Pap test. We currently have insufficient guidance on how to select and deploy implementation strategies most likely to facilitate use of newly recommended cancer screening modality. This project seeks to generate evidence regarding effective strategies to achieve successful implementation of the primary HPV testing for routine cervical cancer screening in a large community-based healthcare delivery system. A successful implementation will be defined by uptake of the primary HPV screening, adequate knowledge of the HPV test for both patients and providers, and patient and provider satisfaction during the transition. This project is important to most adult women, as a timely adoption of the best evidence-based cancer screening approach means better patient outcomes—more cancers prevented and more cancers treated early. Further, the proposed project will inform not only cervical cancer screening, but other clinical conditions for which a physician practice change is recommended by professional societies and/or a national guideline body, such as replacing an outdated or low-value breast cancer screening test. By engaging patients, healthcare providers, and other professional stakeholders in this project, we will ensure that successful project outcomes will be those most important for women and their doctors. Further, the stakeholder partners will help ensure generalizability of our findings to other healthcare systems, design strategies that maximize completeness in data collection, and lead the dissemination effort for wide application of the knowledge to be gained in this project.
Training and Education Interventions
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.