An assessment of gynecological cytology screening practices among health care providers nationwide.
BACKGROUND
The Michigan Public Health Institute and the Michigan Cancer Consortium's Cervical Cancer Committee conducted a national survey of health care providers, thanks to funding from the Centers for Disease Control Cooperative Agreement 5U47CI000743-02. Papanicolaou test screening practices were examined, emphasizing the relationship between clinical and laboratory practices. This survey found differing screening practices among providers of women's health care.


OBJECTIVE
To collect information from family medicine practitioners, women's nurse practitioners, obstetricians and gynecologists, and certified nurse-midwives on Papanicolaou and human papillomavirus testing; to discuss how those practices align with current cytology screening and follow-up recommendations from professional organizations (US Preventive Services Task Force, American Cancer Society, American College of Obstetricians and Gynecologists, and American Society for Colposcopy, and Cervical Pathology); and ultimately, to make recommendations aimed at standardizing practice performance.


METHODS
This survey was conducted in part to examine clinicians' practices and their perceptions of laboratory performance, to evaluate items that are known to enhance quality of care, and to examine factors that may prohibit universal implementation of best standards of care. The survey used a self-administered questionnaire, distributed to 9366 clinicians, with 1601 (17.1%) completed surveys.


RESULTS
This assessment shows a clear lack of consensus among practitioners in performing Papanicolaou testing. It demonstrates how differently patients are tested, based on the providers' screening practices, and demonstrates specific cervical cancer screening practice disparities between and among the 4 provider groups, both in Papanicolaou testing and in the use of human papillomavirus testing.


CONCLUSIONS
A unified mandate for screening is needed to standardize screening practices.
From the Cancer Control Services Program (Dr Darwish-Yassine), the Center for Healthy Communities (Ms Laing), and the Center for Data Management and Translational Research (Mr Wojcik), Michigan Public Health Institute, Okemos; the Cancer Prevention and Control Section, Michigan Department of Community Health, Lansing (Ms Garvin); the Comprehensive Cancer Center (Dr Johnston) and the Department of Obstetrics and Gynecology (Dr Zoschnick), University of Michigan Health System, Ann Arbor; and the Clinical Laboratory, St Joseph Mercy Hospital, Ann Arbor (Ms Conners). Dr Darwish-Yassine is now with Central Administration, Michigan Public Health Institute.
May
M
Darwish-Yassine
Ann D
AD
Garvin
Carolyn M
CM
Johnston
Lauren
L
Zoschnick
Amy
A
Conners
Shannon
S
Laing
Christopher
C
Wojcik
D000328:Adult; D032921:Consensus; D003581:Cytodiagnosis; D003625:Data Collection; D055088:Early Detection of Cancer; D005260:Female; D019983:Guideline Adherence; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008403:Mass Screening; D065006:Papanicolaou Test / Q000379:methods*; D027383:Papillomaviridae / Q000302:isolation & purification*; D017410:Practice Guidelines as Topic; D057184:Practice Patterns, Nurses' / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D055815:Young Adult