Cervical cancer screening: the patient-healthcare provider relationship as a determinant of screening adherence. A qualitative study.

Stephanie Mignot, Nicolas Naiditch, Xavier Fritel

Keywords: pap smear, relation patient heath-care, compliance,

Background:

Performing a pap smear can detect cervical cancer, the 4th leading cause of cancer in women. Despite clear, well-publicized and evidence based recommendations, over a third of women are over-screened. They are exposed to obstetrical complications. Conversely, 51.6% are under screened. Under-screening exacerbates health inequalities because the women least likely to undergo CCS are those most exposed to cervical cancer risks due to sociodemographic and socioeconomic factors. Reducing social inequalities in health is one of the missions of healthcare professionals.

Research questions:

What occure during the encounter patient-prationner that could affect the attitude against CCS.

Method:

Semi-structured interviews were conducted with healthcare professionals between July and December 2022. Theoretical diversity was sought on the following criteria: place of installation, type of profession, type of patient base, private practice or hospital practice. An interview grid was developed and tested. Topics covered included: recommendations, patient profile, relationship, emotional work, over- and under-screening. Interviews were conducted until data saturation was reached (no new data, theoretical diversity). Grounded theory was used for analysis.

Results:

15 midwives, 24 general practitioners and 11 gynecologists from 6 regions were included. The burden of caring for family members placed on some women, the adherence of practitioners and patients to the principle of annual follow-up, the need for negotiation to comply with recommendations, the use of emotions, and the arbitration of prioritizing what is useful for maintaining good health contributed to non-observance of screening.

Conclusions:

Despite the fact that practionners are aware of these recommendations and in agreement with them they could not apply them during the one-on-one meeting with their patient. The search for mutual emotional comfort leads the protagonists to adopt attitudes towards the cervical cancer screening that avoid positioning conflicts, even if this means departing from the recommendations.Recommendation guides should include effective negotiation support models, such as the Health Behavior Model.

Points for discussion:

Should recommendation guides / EBM include effective negotiation support models ?

Health Behavior Model should be includ in EBM approach ?

How take into acompte social inequalities in EBM ?

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