Acceptability of risk-based triage in cervical cancer screening: A focus group study

Sharell Bas; Jasmijn Sijben; Erik W M A Bischoff; Ruud L M Bekkers; Inge M C M de Kok; Willem J G Melchers; Albert G Siebers; Daniëlle van der Waal; Mireille J M Broeders

doi:10.1371/journal.pone.0289647

Acceptability of risk-based triage in cervical cancer screening: A focus group study

Sharell Bas, Jasmijn Sijben, Erik W M A Bischoff, Ruud L M Bekkers, Inge M C M de Kok, Willem J G Melchers, Albert G Siebers, Daniëlle van der Waal, Mireille J M Broeders^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Compared to the previous cytology-based program, the introduction of primary high-risk human papillomavirus (hrHPV) based screening in 2017 has led to an increased number of referrals. To counter this, triage of hrHPV-positive women in cervical cancer screening can potentially be optimized by taking sociodemographic and lifestyle risk factors for cervical abnormalities into account. Therefore, it is essential to gain knowledge of the views of women (30-60 years) eligible for cervical cancer screening. OBJECTIVE: The main goal of this qualitative study was to gain insight in the aspects that influence acceptability of risk-based triage in cervical cancer screening. DESIGN: A focus group study in which participants were recruited via four general medical practices, and purposive sampling was used to maximize heterogeneity with regards to age, education level, and cervical cancer screening experiences. APPROACH: The focus group discussions were transcribed verbatim and analyzed using reflexive thematic analysis. PARTICIPANTS: A total of 28 women (average age: 45.2 years) eligible for cervical cancer screening in The Netherlands participated in seven online focus group discussions. Half of the participants was higher educated, and the participants differed in previous cervical cancer screening participation and screening result. KEY RESULTS: In total, 5 main themes and 17 subthemes were identified that determine the acceptability of risk-stratified triage. The main themes are: 1) adequacy of the screening program: an evidence-based program that is able to minimize cancer incidence and reduce unnecessary referrals; 2) personal information (e.g., sensitive topics and stigma); 3) emotional impact: fear and reassurance; 4) communication (e.g., transparency); and 5) autonomy (e.g., prevention). CONCLUSION: The current study highlights several challenges regarding the development and implementation of risk-based triage that need attention in order to be accepted by the target group. These challenges include dealing with sensitive topics and a transparent communication strategy.

Original language	English
Article number	e0289647
Number of pages	14
Journal	PLOS ONE
Volume	18
Issue number	8
DOIs	https://doi.org/10.1371/journal.pone.0289647
Publication status	Published - 16 Aug 2023

Keywords

Female
Humans
Middle Aged
Pregnancy
Uterine Cervical Neoplasms
Early Detection of Cancer
Triage
Focus Groups
Cytodiagnosis
Papillomavirus Infections
Uterine Cervical Dysplasia/diagnosis
Papillomaviridae
Mass Screening
Colposcopy

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10.1371/journal.pone.0289647Licence: CC BY

Cite this

@article{155a2cf6cc45424babfd7ab59fe07792,

title = "Acceptability of risk-based triage in cervical cancer screening: A focus group study",

abstract = "BACKGROUND: Compared to the previous cytology-based program, the introduction of primary high-risk human papillomavirus (hrHPV) based screening in 2017 has led to an increased number of referrals. To counter this, triage of hrHPV-positive women in cervical cancer screening can potentially be optimized by taking sociodemographic and lifestyle risk factors for cervical abnormalities into account. Therefore, it is essential to gain knowledge of the views of women (30-60 years) eligible for cervical cancer screening. OBJECTIVE: The main goal of this qualitative study was to gain insight in the aspects that influence acceptability of risk-based triage in cervical cancer screening. DESIGN: A focus group study in which participants were recruited via four general medical practices, and purposive sampling was used to maximize heterogeneity with regards to age, education level, and cervical cancer screening experiences. APPROACH: The focus group discussions were transcribed verbatim and analyzed using reflexive thematic analysis. PARTICIPANTS: A total of 28 women (average age: 45.2 years) eligible for cervical cancer screening in The Netherlands participated in seven online focus group discussions. Half of the participants was higher educated, and the participants differed in previous cervical cancer screening participation and screening result. KEY RESULTS: In total, 5 main themes and 17 subthemes were identified that determine the acceptability of risk-stratified triage. The main themes are: 1) adequacy of the screening program: an evidence-based program that is able to minimize cancer incidence and reduce unnecessary referrals; 2) personal information (e.g., sensitive topics and stigma); 3) emotional impact: fear and reassurance; 4) communication (e.g., transparency); and 5) autonomy (e.g., prevention). CONCLUSION: The current study highlights several challenges regarding the development and implementation of risk-based triage that need attention in order to be accepted by the target group. These challenges include dealing with sensitive topics and a transparent communication strategy.",

keywords = "Female, Humans, Middle Aged, Pregnancy, Uterine Cervical Neoplasms, Early Detection of Cancer, Triage, Focus Groups, Cytodiagnosis, Papillomavirus Infections, Uterine Cervical Dysplasia/diagnosis, Papillomaviridae, Mass Screening, Colposcopy",

author = "Sharell Bas and Jasmijn Sijben and Bischoff, {Erik W M A} and Bekkers, {Ruud L M} and {de Kok}, {Inge M C M} and Melchers, {Willem J G} and Siebers, {Albert G} and {van der Waal}, Dani{\"e}lle and Broeders, {Mireille J M}",

year = "2023",

month = aug,

day = "16",

doi = "10.1371/journal.pone.0289647",

language = "English",

volume = "18",

journal = "PLOS ONE",

issn = "1932-6203",

publisher = "Public Library of Science",

number = "8",

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TY - JOUR

T1 - Acceptability of risk-based triage in cervical cancer screening

T2 - A focus group study

AU - Bas, Sharell

AU - Sijben, Jasmijn

AU - Bischoff, Erik W M A

AU - Bekkers, Ruud L M

AU - de Kok, Inge M C M

AU - Melchers, Willem J G

AU - Siebers, Albert G

AU - van der Waal, Daniëlle

AU - Broeders, Mireille J M

PY - 2023/8/16

Y1 - 2023/8/16

N2 - BACKGROUND: Compared to the previous cytology-based program, the introduction of primary high-risk human papillomavirus (hrHPV) based screening in 2017 has led to an increased number of referrals. To counter this, triage of hrHPV-positive women in cervical cancer screening can potentially be optimized by taking sociodemographic and lifestyle risk factors for cervical abnormalities into account. Therefore, it is essential to gain knowledge of the views of women (30-60 years) eligible for cervical cancer screening. OBJECTIVE: The main goal of this qualitative study was to gain insight in the aspects that influence acceptability of risk-based triage in cervical cancer screening. DESIGN: A focus group study in which participants were recruited via four general medical practices, and purposive sampling was used to maximize heterogeneity with regards to age, education level, and cervical cancer screening experiences. APPROACH: The focus group discussions were transcribed verbatim and analyzed using reflexive thematic analysis. PARTICIPANTS: A total of 28 women (average age: 45.2 years) eligible for cervical cancer screening in The Netherlands participated in seven online focus group discussions. Half of the participants was higher educated, and the participants differed in previous cervical cancer screening participation and screening result. KEY RESULTS: In total, 5 main themes and 17 subthemes were identified that determine the acceptability of risk-stratified triage. The main themes are: 1) adequacy of the screening program: an evidence-based program that is able to minimize cancer incidence and reduce unnecessary referrals; 2) personal information (e.g., sensitive topics and stigma); 3) emotional impact: fear and reassurance; 4) communication (e.g., transparency); and 5) autonomy (e.g., prevention). CONCLUSION: The current study highlights several challenges regarding the development and implementation of risk-based triage that need attention in order to be accepted by the target group. These challenges include dealing with sensitive topics and a transparent communication strategy.

AB - BACKGROUND: Compared to the previous cytology-based program, the introduction of primary high-risk human papillomavirus (hrHPV) based screening in 2017 has led to an increased number of referrals. To counter this, triage of hrHPV-positive women in cervical cancer screening can potentially be optimized by taking sociodemographic and lifestyle risk factors for cervical abnormalities into account. Therefore, it is essential to gain knowledge of the views of women (30-60 years) eligible for cervical cancer screening. OBJECTIVE: The main goal of this qualitative study was to gain insight in the aspects that influence acceptability of risk-based triage in cervical cancer screening. DESIGN: A focus group study in which participants were recruited via four general medical practices, and purposive sampling was used to maximize heterogeneity with regards to age, education level, and cervical cancer screening experiences. APPROACH: The focus group discussions were transcribed verbatim and analyzed using reflexive thematic analysis. PARTICIPANTS: A total of 28 women (average age: 45.2 years) eligible for cervical cancer screening in The Netherlands participated in seven online focus group discussions. Half of the participants was higher educated, and the participants differed in previous cervical cancer screening participation and screening result. KEY RESULTS: In total, 5 main themes and 17 subthemes were identified that determine the acceptability of risk-stratified triage. The main themes are: 1) adequacy of the screening program: an evidence-based program that is able to minimize cancer incidence and reduce unnecessary referrals; 2) personal information (e.g., sensitive topics and stigma); 3) emotional impact: fear and reassurance; 4) communication (e.g., transparency); and 5) autonomy (e.g., prevention). CONCLUSION: The current study highlights several challenges regarding the development and implementation of risk-based triage that need attention in order to be accepted by the target group. These challenges include dealing with sensitive topics and a transparent communication strategy.

KW - Female

KW - Humans

KW - Middle Aged

KW - Pregnancy

KW - Uterine Cervical Neoplasms

KW - Early Detection of Cancer

KW - Triage

KW - Focus Groups

KW - Cytodiagnosis

KW - Papillomavirus Infections

KW - Uterine Cervical Dysplasia/diagnosis

KW - Papillomaviridae

KW - Mass Screening

KW - Colposcopy

U2 - 10.1371/journal.pone.0289647

DO - 10.1371/journal.pone.0289647

M3 - Article

SN - 1932-6203

VL - 18

JO - PLOS ONE

JF - PLOS ONE

IS - 8

M1 - e0289647

ER -