Abstract：
BACKGROUND: The 2020 American Cancer Society (ACS) guidelines are the most recent national guidelines for cervical cancer screening. These guidelines propose two major changes from current practice: initiating screening at age 25 years and using primary human papillomavirus (HPV) testing. Adoption of guidelines often occurs slowly, and therefore understanding clinician attitudes is important to facilitate practice change.
METHODS: Interviews with a national sample of clinicians who perform cervical cancer screening in a variety of settings explored attitudes toward the two major changes from the 2020 ACS cervical cancer screening guidelines. Clinicians participated in 30- to 60-min interviews exploring their attitudes toward various aspects of cervical cancer screening. Qualitative analysis was performed.
RESULTS: Seventy clinicians participated from across the United States. Few respondents were initiating screening at age 25 years, and none were using primary HPV testing. However, over half would be willing to adopt these practices if supported by scientific evidence and recommended by professional medical organizations. Barriers to adoption included the lack of endorsement by professional societies, lack of laboratory availability and insurance coverage, limited autonomy within large health care systems, and concerns related to missed disease.
CONCLUSIONS: Few clinicians have adopted screening initiation or primary HPV testing, as recommended by the 2020 ACS guidelines, but over half were open to adopting these changes. Implementation may be facilitated via professional organization endorsement, clinician education, and laboratory, health care system, and insurance support.
CONCLUSIONS: In 2020, the American Cancer Society (ACS) released updated guidelines for cervical cancer screening. The main changes to current practices were to initiate screening at age 25 years instead of age 21 years and to screen using primary human papillomavirus (HPV) testing rather than cytology alone or in combination with HPV testing. We performed in-depth interviews with 70 obstetrics and gynecology, family medicine, and internal medicine physicians and advanced practice providers about their attitudes toward these guidelines. Few clinicians are following the 2020 ACS guidelines, but over half were open to changing practice if the changes were supported by evidence and recommended by professional medical organizations. Barriers to adoption included the lack of endorsement by professional medical organizations, logistical issues, and concerns about missed disease.
METHODS: Interviews with a national sample of clinicians who perform cervical cancer screening in a variety of settings explored attitudes toward the two major changes from the 2020 ACS cervical cancer screening guidelines. Clinicians participated in 30- to 60-min interviews exploring their attitudes toward various aspects of cervical cancer screening. Qualitative analysis was performed.
RESULTS: Seventy clinicians participated from across the United States. Few respondents were initiating screening at age 25 years, and none were using primary HPV testing. However, over half would be willing to adopt these practices if supported by scientific evidence and recommended by professional medical organizations. Barriers to adoption included the lack of endorsement by professional societies, lack of laboratory availability and insurance coverage, limited autonomy within large health care systems, and concerns related to missed disease.
CONCLUSIONS: Few clinicians have adopted screening initiation or primary HPV testing, as recommended by the 2020 ACS guidelines, but over half were open to adopting these changes. Implementation may be facilitated via professional organization endorsement, clinician education, and laboratory, health care system, and insurance support.
CONCLUSIONS: In 2020, the American Cancer Society (ACS) released updated guidelines for cervical cancer screening. The main changes to current practices were to initiate screening at age 25 years instead of age 21 years and to screen using primary human papillomavirus (HPV) testing rather than cytology alone or in combination with HPV testing. We performed in-depth interviews with 70 obstetrics and gynecology, family medicine, and internal medicine physicians and advanced practice providers about their attitudes toward these guidelines. Few clinicians are following the 2020 ACS guidelines, but over half were open to changing practice if the changes were supported by evidence and recommended by professional medical organizations. Barriers to adoption included the lack of endorsement by professional medical organizations, logistical issues, and concerns about missed disease.
摘要：
背景：2020年美国癌症协会（ACS）指南是最新的国家宫颈癌筛查指南。这些指南提出了当前实践的两个主要变化：在25岁时开始筛查和使用原发性人乳头瘤病毒（HPV）检测。准则的采纳往往进展缓慢，因此，了解临床医生的态度对于促进实践改变很重要。
方法：对在各种环境中进行宫颈癌筛查的全国临床医生进行访谈，探讨了对2020年ACS宫颈癌筛查指南的两个主要变化的态度。临床医生参加了30至60分钟的访谈，探讨了他们对宫颈癌筛查各个方面的态度。进行定性分析。
结果：来自美国各地的70名临床医生参与。很少有受访者在25岁时开始筛查，没有人使用原发性HPV检测。然而,如果得到科学证据的支持和专业医疗组织的建议，超过一半的人愿意采用这些做法。收养的障碍包括缺乏专业协会的认可，缺乏实验室可用性和保险范围，大型医疗保健系统内的自主权有限，以及与错过疾病有关的担忧。
结论：很少有临床医生采用筛查起始或HPV原发检测，根据2020年ACS指南的建议，但超过一半的人愿意接受这些改变。可通过专业组织认可促进实施，临床医师教育，实验室,卫生保健系统,保险支持。
结论：2020年，美国癌症协会（ACS）发布了更新的宫颈癌筛查指南。当前实践的主要变化是在25岁而不是21岁时开始筛查，并使用原发性人乳头瘤病毒（HPV）检测进行筛查，而不是单独进行细胞学检查或与HPV检测相结合。我们对70名妇产科进行了深入访谈，家庭医学,以及内科医师和高级实践提供者对这些指南的态度。很少有临床医生遵循2020ACS指南，但是，如果有证据支持并由专业医疗组织推荐，则超过一半的人愿意改变实践。收养的障碍包括缺乏专业医疗组织的认可，后勤问题,以及对错过疾病的担忧。
方法：对在各种环境中进行宫颈癌筛查的全国临床医生进行访谈，探讨了对2020年ACS宫颈癌筛查指南的两个主要变化的态度。临床医生参加了30至60分钟的访谈，探讨了他们对宫颈癌筛查各个方面的态度。进行定性分析。
结果：来自美国各地的70名临床医生参与。很少有受访者在25岁时开始筛查，没有人使用原发性HPV检测。然而,如果得到科学证据的支持和专业医疗组织的建议，超过一半的人愿意采用这些做法。收养的障碍包括缺乏专业协会的认可，缺乏实验室可用性和保险范围，大型医疗保健系统内的自主权有限，以及与错过疾病有关的担忧。
结论：很少有临床医生采用筛查起始或HPV原发检测，根据2020年ACS指南的建议，但超过一半的人愿意接受这些改变。可通过专业组织认可促进实施，临床医师教育，实验室,卫生保健系统,保险支持。
结论：2020年，美国癌症协会（ACS）发布了更新的宫颈癌筛查指南。当前实践的主要变化是在25岁而不是21岁时开始筛查，并使用原发性人乳头瘤病毒（HPV）检测进行筛查，而不是单独进行细胞学检查或与HPV检测相结合。我们对70名妇产科进行了深入访谈，家庭医学,以及内科医师和高级实践提供者对这些指南的态度。很少有临床医生遵循2020ACS指南，但是，如果有证据支持并由专业医疗组织推荐，则超过一半的人愿意改变实践。收养的障碍包括缺乏专业医疗组织的认可，后勤问题,以及对错过疾病的担忧。
