PDF(Pubmed)
Abstract：
BACKGROUND: Cervical cancer is a preventable and treatable form of cancer yet continues to be the fourth most common cancer among women globally. Primary care is the first point of contact most patients have with health services and is where most cancer prevention and early detection occur. Inadequate follow-up of abnormal test results for cervical abnormalities in primary care can lead to suboptimal patient outcomes including higher mortality and decreased quality of life.
OBJECTIVE: To explore the magnitude of and factors associated with, inadequate follow-up of test results for cervical abnormalities in primary and ambulatory care.
METHODS: MEDLINE, Embase, Cochrane Library and CINAHL were searched for peer-reviewed literature from 2000-2022, excluding case-studies, grey literature, and systematic reviews. Studies were included if they reported on patients aged ≥ 18 years with no previous cancer diagnosis, in a primary care/ambulatory setting. Risk of bias was assessed using the Joanna Briggs Institute Critical appraisal checklists, appropriate to the study design. A segregated methodology was used to perform a narrative synthesis, maintaining the distinction between quantitative and qualitative research.
RESULTS: We included 27 publications reporting on 26 studies in our review; all were conducted in high-income countries. They included 265,041 participants from a variety of ambulatory settings such as family medicine, primary care, women\'s services, and colposcopy clinics. Rates of inadequate follow-up ranged from 4 to 75%. Studies reported 41 different factors associated with inadequate follow-up. Personal factors associated with inadequate follow-up included younger age, lower education, and socioeconomic status. Psychological factors were reported by only 3/26 studies and 2/3 found no significant association. System protective factors included the presence of a regular primary care provider and direct notification of abnormal test results.
CONCLUSIONS: This review describes inadequate follow-up of abnormal cervical abnormalities in primary care. Prevalence varied and the evidence about causal factors is unclear. Most interventions evaluated were effective in decreasing inadequate follow-up. Examples of effective interventions were appointment reminders via telephone, direct notification of laboratory results, and HPV self-sampling. Even though rates of cervical cancer have decreased over the years, there is a lack of information on factors affecting follow-up in primary care and ambulatory settings, particularly in low and middle-income countries. This information is crucial if we are to achieve WHO\'s interim targets by 2030, and hope to avert 62 million cervical cancer deaths by 2120.
BACKGROUND: PROSPERO ID CRD42021250136.
OBJECTIVE: To explore the magnitude of and factors associated with, inadequate follow-up of test results for cervical abnormalities in primary and ambulatory care.
METHODS: MEDLINE, Embase, Cochrane Library and CINAHL were searched for peer-reviewed literature from 2000-2022, excluding case-studies, grey literature, and systematic reviews. Studies were included if they reported on patients aged ≥ 18 years with no previous cancer diagnosis, in a primary care/ambulatory setting. Risk of bias was assessed using the Joanna Briggs Institute Critical appraisal checklists, appropriate to the study design. A segregated methodology was used to perform a narrative synthesis, maintaining the distinction between quantitative and qualitative research.
RESULTS: We included 27 publications reporting on 26 studies in our review; all were conducted in high-income countries. They included 265,041 participants from a variety of ambulatory settings such as family medicine, primary care, women\'s services, and colposcopy clinics. Rates of inadequate follow-up ranged from 4 to 75%. Studies reported 41 different factors associated with inadequate follow-up. Personal factors associated with inadequate follow-up included younger age, lower education, and socioeconomic status. Psychological factors were reported by only 3/26 studies and 2/3 found no significant association. System protective factors included the presence of a regular primary care provider and direct notification of abnormal test results.
CONCLUSIONS: This review describes inadequate follow-up of abnormal cervical abnormalities in primary care. Prevalence varied and the evidence about causal factors is unclear. Most interventions evaluated were effective in decreasing inadequate follow-up. Examples of effective interventions were appointment reminders via telephone, direct notification of laboratory results, and HPV self-sampling. Even though rates of cervical cancer have decreased over the years, there is a lack of information on factors affecting follow-up in primary care and ambulatory settings, particularly in low and middle-income countries. This information is crucial if we are to achieve WHO\'s interim targets by 2030, and hope to avert 62 million cervical cancer deaths by 2120.
BACKGROUND: PROSPERO ID CRD42021250136.
摘要：
背景：宫颈癌是一种可预防和可治疗的癌症，但仍是全球女性中第四常见的癌症。初级保健是大多数患者与卫生服务的第一个接触点，也是大多数癌症预防和早期发现的地方。在初级保健中，对宫颈异常的异常检测结果的随访不足会导致患者预后欠佳，包括更高的死亡率和生活质量下降。
目的：探讨与之相关的程度和因素，在初级护理和门诊护理中，宫颈异常的测试结果随访不足。
方法：MEDLINE，Embase,搜索了Cochrane图书馆和CINAHL2000-2022年的同行评审文献，不包括案例研究，灰色文学，和系统的审查。如果研究报告的患者年龄≥18岁，以前没有癌症诊断，在初级保健/门诊环境中。使用JoannaBriggs研究所关键评估清单评估偏差风险，适合研究设计。一种分离的方法被用来进行叙事综合，保持定量研究和定性研究的区别。
结果：我们纳入了27篇出版物，报告了26项研究；所有研究均在高收入国家进行。他们包括265,041名来自家庭医学等各种门诊环境的参与者，初级保健,妇女服务，还有阴道镜诊所.随访不足的比率为4％至75％。研究报告了41种与随访不足相关的不同因素。与随访不足相关的个人因素包括年龄较小，教育水平较低,和社会经济地位。只有3/26的研究报告了心理因素，2/3的研究没有发现明显的关联。系统保护因素包括正规初级保健提供者的存在和异常测试结果的直接通知。
结论：本综述描述了初级护理中异常宫颈异常的随访不足。患病率各不相同，有关因果关系的证据尚不清楚。评估的大多数干预措施有效地减少了随访不足。有效干预措施的例子是通过电话预约提醒，直接通知实验室结果，和HPV自我取样。尽管多年来宫颈癌的发病率有所下降，缺乏有关影响初级保健和门诊随访的因素的信息，特别是在低收入和中等收入国家。如果我们要在2030年前实现世卫组织的中期目标，并希望在2120年前避免6200万宫颈癌死亡，这些信息至关重要。
背景：PROSPEROIDCRD42021250136。
目的：探讨与之相关的程度和因素，在初级护理和门诊护理中，宫颈异常的测试结果随访不足。
方法：MEDLINE，Embase,搜索了Cochrane图书馆和CINAHL2000-2022年的同行评审文献，不包括案例研究，灰色文学，和系统的审查。如果研究报告的患者年龄≥18岁，以前没有癌症诊断，在初级保健/门诊环境中。使用JoannaBriggs研究所关键评估清单评估偏差风险，适合研究设计。一种分离的方法被用来进行叙事综合，保持定量研究和定性研究的区别。
结果：我们纳入了27篇出版物，报告了26项研究；所有研究均在高收入国家进行。他们包括265,041名来自家庭医学等各种门诊环境的参与者，初级保健,妇女服务，还有阴道镜诊所.随访不足的比率为4％至75％。研究报告了41种与随访不足相关的不同因素。与随访不足相关的个人因素包括年龄较小，教育水平较低,和社会经济地位。只有3/26的研究报告了心理因素，2/3的研究没有发现明显的关联。系统保护因素包括正规初级保健提供者的存在和异常测试结果的直接通知。
结论：本综述描述了初级护理中异常宫颈异常的随访不足。患病率各不相同，有关因果关系的证据尚不清楚。评估的大多数干预措施有效地减少了随访不足。有效干预措施的例子是通过电话预约提醒，直接通知实验室结果，和HPV自我取样。尽管多年来宫颈癌的发病率有所下降，缺乏有关影响初级保健和门诊随访的因素的信息，特别是在低收入和中等收入国家。如果我们要在2030年前实现世卫组织的中期目标，并希望在2120年前避免6200万宫颈癌死亡，这些信息至关重要。
背景：PROSPEROIDCRD42021250136。
