Cancer Control Research
1R03CA059205-01
Klassen, Ann C.
IMPROVING CERVICAL CANCER SCREENING IN HOSPITAL SETTINGS
AbstractThis project proposes to examine and improve the processes by which older
women receive a Papanicolaou (Pap) smear test for cervical cancer during
hospital stays in the state of Maryland. Screening for the early
detection of cervical cancer is vital for older women, who bear a high
mortality from this essentially preventable cancer. Hospital admissions
represent an opportunity for screening these women, who are unlikely to
use obstetrician gynecologists or family planning clinics. Maryland law
requires all hospitalized women to be offered a Pap test; however, older,
low income and chronically ill women do not appear to receive hospital
screening. Variation among hospital policy and physician attitudes and
practices necessitates evaluation of organizational and behavioral
factors in each hospital if legislation is to improve screening. The
objectives of the project are to gather information on organizational and
behavioral factors influencing the screening of older women for cervical
cancer during hospital stays, and to provide specific recommendations to
hospitals and cancer control agencies for improving hospital screening
rates. Its purpose is to improve screening for older women within
existing patterns of health care utilization, rather than by persuading
older women to seek additional care for cervical screening. All
hospitals in Maryland will be contacted in order to evaluate each
hospital's approach to screening female admissions for cervical cancer.
Organizational and policy characteristics of each hospital will be
examined, as well as information on how a Pap test is done in each
hospital - who orders them, who performs them, and what, if any, reminder
system exists. Next, using computerized discharge data will be used to
determine hospital-specific admissions patterns for older women (volume,
reason for admission, type of physician, service area, length of stay).
Using these two data sources, a sample of Maryland hospitals, and
physicians within these hospitals, will be developed, providing a
representative selection of care settings with regard to older women
patients, and organizational characteristics influencing Pap testing.
Providers within hospitals will be selected by medical specialty, rank,
age and volume of older patients. Sampled physicians will be asked to
complete a mailed survey interview, which will measure knowledge,
attitudes, and practices related to screening elderly women for cervical
cancer. Physician and hospital data will be analyzed together to
identify organizational barriers related to attitudes and practices
associated with poor screening rates.
|