title: Cervical cancer screening practices of certified nurse-midwives in the United States.
abstract: The purpose of this study was to determine how closely certified nurse-midwives in the United States follow contemporary cervical cancer screening guidelines. A survey was sent to 264 randomly selected certified nurse-midwives. Survey questions included demographics and clinical scenarios addressing initiation, frequency, and cessation of screening. Responses were received from 60% of the sampled certified nurse-midwives who had valid mailing addresses; 127 were eligible for the analytic sample. Many nurse-midwives initiate cervical cancer screening earlier than guidelines recommend; 72% would initiate screening in an 18-year-old within 1 month of coitarche, while 36% would begin screening virginal girls at age 18, and many continue cervical cancer screening after guidelines recommend cessation. More than 60% of the respondents would continue screening a woman who had undergone total hysterectomy for symptomatic fibroids who had no history of dysplasia, and half would continue to screen a 70-year-old woman with a 30-year history of previous normal Pap tests. In addition, despite guidelines which recommend less frequent screening, more than one-quarter (28%) would continue annual screening in a 35-year-old woman with three or more normal tests. Certified nurse-midwives are performing cervical cancer screening more frequently than current guidelines recommend. Comparisons to the practice of other providers are offered. Education to limit unnecessary testing is needed.
authors.affiliation: University of Utah College of Nursing in Salt Lake City, UT 84112, USA. patricia.murphy@nurs.utah.edu
authors.forename: Patricia Aikins
authors.initials: PA
authors.lastname: Murphy
authors.forename: Eleanor Bimla
authors.initials: EB
authors.lastname: Schwarz
authors.forename: Jane M
authors.initials: JM
authors.lastname: Dyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019985:Benchmarking; D002568:Certification / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008875:Middle Aged; D008880:Midwifery / Q000592:standards*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000451:nursing* / Q000517:prevention & control; D014626:Vaginal Smears / Q000706:statistics & numerical data*