Barriers and Facilitators to Adherence to Follow-up for Abnormal Cervical Cytology: A Review of the Evidence with Implications for Clinical Practice
Advisor:von Sadovszky, Victoria
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Publisher:The Ohio State University
Series/Report no.:The Ohio State University College of Nursing Doctor of Nursing Practice Final Document Projects
Cervical cancer is one of the most preventable cancers because of its slow progression, cytologically identifiable precursors and effective treatments (Leyden et al., 2005). However, it remains the third most common gynecological cancer, leading to an unnecessary number of deaths annually (Brookfield, Cheung, Lucci, Fleming & Koniaris, 2009). The key to decreasing the incidence of cervical cancer deaths begins with screening Pap smears and adherence with recommended follow-up care for abnormal results. Transportation, childcare issues, financial constraints, and need for reminders are consistently recognized as barriers to follow-up care (Abercrombie, 2001). Transportation and financial incentives, reminders, patient educational materials, and case management are effective facilitators to follow-up (Engelstad et al., 2005). Despite an automated reminder call system and transportation incentives being available at Muskingum Valley Health Centers (MVHC), the number of patients who do not return for follow-up appointments remains high. The purpose of this evidence-based practice (EBP) project was to ascertain common barriers and facilitators that either prevent or help patients make return visits and interventions that could increase adherence for return visits. To that end, this EBP project includes a thorough review and synthesis of the literature and a survey of the patients seeking care in the gynecology service line at Muskingum Valley Health Centers to understand their perspective about barriers and facilitators to plan for future interventions at the center. An extensive literature review was conducted utilizing several different data bases in order to find the highest level of evidence. During this process, the search methods were validated by a Health Sciences Librarian who is has experience in EBP. After obtaining the literature, it was analyzed and compared to the information obtained from the questionnaires from MVHC. The evidence was then used to determine the barriers and facilitators to follow-up care for the patients at MVHC. Based on the evidence and findings, amendable changes were determined.