Evidence-based practice project to increase hospital-based cervical cancer screening compliance among registration staff

  • Lynn Richards-McDonald Johns Hopkins Hospital
Keywords: Cervical cancer, screening, cervical cancer knowledge and awareness education, evidence-based practice, cervical cancer screening compliance, hospital-based


Background: High-quality Papanicolaou testing was developed in the 1940s, and when used for early detection of cervical cancer, has been shown to significantly reduce cervical cancer related deaths world-wide. Legislation, passed by many states in the United States, aims to maximize cervical cancer screening. One academic medical center (AMC) in Maryland initiated a cervical cancer screening program in 1977. A pilot, developed to assess cervical cancer screening compliance, found the screening rate at this AMC to be 51%.

Objective: This project aimed to improve the knowledge of the patient service coordinators in order to increase cervical cancer screening compliance.

Population: Patient service coordinator conducts registration and screening when a patient is admitted to the AMC

Methods: Effectiveness of the education was measured by three assessments: 1) A pre and post knowledge survey of the patient service coordinator measuring facts about cervical cancer, the screening process, and the State of Maryland cervical cancer screening mandate; 2) a calculation of screening rates comparing the number of women screened to the number of women admitted; and 3) an assessment of the completeness of each screening form.

Results: A two-tailed paired samples t-test revealed that the PSCs scored higher on the post-survey (m-7.68, s- 2.52) compared to the pre-survey (m-3.68, s-1.77), t (32) = 8.949, p ≤ .0.5. A chi- square test was used to compare categorical variables. During the four weeks before the educational intervention, 34% (543 of 1602) of women were screened; 51% (279/543) screening forms were completed. For the four weeks after the educational intervention, 54% (N=735 of 1,373) of eligible women were screened; 89% (656/735) forms were completed. Both tests were found to be significant p <0.000.

Interpretation: There was a significant improvement of the PSC’s knowledge, 20% increase in the number of women screened, and completeness of the form increased by 38%.

Conclusion: These findings suggest that an educational intervention for registration staff can increase cervical cancer screening compliance, and positively impact staff ability to screen inpatient women.

Author Biography

Lynn Richards-McDonald, Johns Hopkins Hospital
Department of Gynecology and Obstetrics


American Cancer Society (2014). What are the risk factors for cervical cancer? Retrieved from http:// http://www.cancer.org/cancer/cervicalcancer/detailedguide/cervical-cancer-risk-factors

Boyce, J., Fruchter, R., Thompson, M., Conly, C., Jones, M., Maloney, J., & Bloomfield, R. (1981). Cervical cancer screening; Need among hospital inpatients. NY State Journal of Medicine, 81(3), 331-333.

Centers for Disease Control and Prevention. (2012). Cervical cancer screening. Retrieved February 3, 2013, from http://www.cdc.gov/cancer/cervical/basic_info/screening.htm

Cook, N., Hart, A., Nuttall, K., Simpson, K., Turnill, N., Grant-Pearce, C.,…Dey, P. (2011). A telephone survey of cancer awareness among frontline staff. Informing training needs. British Journal of Cancer, 105(4), 340-345. doi:10.138/bjc.2011.258

Daley, E., Alio, A., Anstey, E. H., Chandler, R., Dyer, K., & Helmy, H. (2011). Examining barriers to cervical cancer screening and treatment in Florida through a social-ecological lens. Journal of Community Health, 36(1), 121-131. doi:10.1007/s10900.010-9289-7

Du Toit, J. P., & van Niekerk, W. A. (1978). Cervical cytologic screening among females with nongynecologic hospital admissions. Obstetrics and Gynecology, 51(3), 342-346. doi:10.1097/00006250-197803000-00019

Duncan, G. R., & Parker, R. E. (1981). Cervical cytology screening among females of non-gynaecological hospital inpatients. Australian and New Zealand Journal of Obstetrics and Gynaecology, 21(2), 113-115. doi:10.1111/j.1479-828x.1981.tb00794.x

English, K. C., Merzel, C., & Moon-Howard, J. (2010). Translating public health knowledge into practice: Development of a lay health advisor perinatal tobacco cessation program. Journal Public Health Management and Practice, 16(3), E9-E19. doi:10.1097/PHH.0b013e3181af6387

Eversole, G. M., Moriarity, A. T., Schwartz, M. R., Clayton, A. C., Souers, R., & Fatheree, L. A.,...Wilbur, D. C. (2010). Practices of participants in the Colleges of American Pathologists Interlaboratory comparison program in cervicovaginal cytology, 2006. Archives of Pathology & Laboratory Medicine, 134(3), 331-335. doi:10.43/1543-2145-134.3.331

Fisher, R., & Donohoe, E. (1988). Emerging trends in clinical preventive services: State health care coverage laws and employees wellness benefits. Washington, DC: Intergovernmental Health Project, George Washington University.

Foley, S. F. (1987). Preventive gynecologic nursing in an inpatient setting. JOGNN, 16(3), 160-166. doi:10.1111/J.1552-6909.1987.tb01452.x

Gharoro, E. P., & Ikeanyi, E. N. (2006). An appraisal of the level of awareness and utilization of the Pap smear as a cervical cancer screening test among female health workers in a tertiary health institution. International Journal of Gynecological Cancer, 16(3), 1063-1068.

Gwede, C. K., Ashley, A. A., McGinnis, K., Montiel-Ishino, A., Standifer, M., Baldwin, J.,...Green, B. L. (2013). Designing a community-based lay health advisors training curriculum to address cancer health disparities. Health Promotion Practice, 14(3), 415-424. doi:10.1177/1524839912458675

Han, H. R., Kim, J., Lee, J. E., Hedlin, H. K., Song, Y., & Kim, M. T. (2011). Interventions that increase use of Pap tests among ethnic minority women: a meta-analysis. Psychooncology, 20(4), 341-351. doi:10.1002/pon.1754

Hudson, S., Hewerston, S., Jansz, C., & Gordon, H. (1983). Screening hospital patients for uterine cervical cancer. Journal of Clinical Pathology, 36(6), 611-615. doi:10.1136/jcp.36.6.611

MD. Code Ann. Health Gen. Law § 19-348 (2012). Examination for cervical cancer;

mammography materials. Retrieved from http://www.lexisnexis.com/hottopics/mdcode/

Moore-Monroy, M., Wilkinson-Lee, A. M., Verdugo, L., Paez, L., Rodriguez, D., Wilhelm, M., & Garcia, F. (2013). Addressing the information gap: Developing and implementing a cervical cancer prevention education campaign grounded in principles of community-based participating action. Health Promotion Practice, 14(2), 274-283. doi:10.1177/1524839912454141

Mutyaba, T., Mmiro, F. A., & Weiderpass, E. (2006). Knowledge, attitudes and practices in cervical cancer screening among the medical workers of Mulago Hospital, Uganda. Bio Med Central Medical Education, 6(13), 1-4. doi:10.1186/1472-6920-6-13

National Cancer Institute. (2010). Cancer advances in focus- Cervical cancer. Retrieved February 3, 2013, from http://www.cancer.gov/cancertopics/factsheet/cancer-advances-in-focus/cervical

Oranratanaphan, S., Amatyakul, P., Iramaneera, T. K., & Srithipayawan, S. (2010). Knowledge, attitudes and practices about the Pap smear among medical workers in Naresuan University Hospital. Asian Pacific Journal of Cancer Prevention, 11(6), 1727-1730.

Richards, L. A., & Klemm, P. (2000). An inpatient cervical cancer screening program to reach underserved women. Journal of Obstetrics Gynecologic and Neonatal Nursing, 29(5), 465-473. doi:10.1111/j1552-6909.2000tb02767.x

Sasieni, P., Castonon, A., & Cusick, J. (2009). Effectiveness of cervical cancer screening with age, population based case control of prospectively recorded data. British Medical Journal, 339(2968), 1-7.

Saslow, D., Solomon, D., Lawson, H. W., Killackey, M., Kulasingam, S. L., Cain, J.,...The ACS-ASCCP-ASCP Cervical Cancer Guideline Committee (2012). American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology Screening guidelines for the prevention and early detection of cervical cancer. CA: A Cancer Journal for Clinicians, 62(3), 147-172. doi:10.1309/AJCPTGD94EVRSJCG

Sargeant, E. J., Qizilbash, A. H., & Johnson, F. L. (1977). Cervical cytology: Experience of a general hospital. Canadian Medical Association Journal, 117(9), 1026-1027.

Spencer, M. S., Rosland, A., Kieffer, E. C., Sinco, B. R., Valerio, M., Palmisano, G.,...Heisler, M. (2011). Effectiveness of a community health worker intervention among African American and Latino adults with type 2 diabetes: A randomized control trial. American Public Health Association, 101(2), 2253-2260. doi:10.2105/AJPH.2010.300106

Stone, E. G., Morton, S. C., Hulscher, M. E., Maglione, M. A., Roth, E. A., & Grimshaw, J. (2002). Interventions that increase use of adult immunization and cancer screening services. Annals of Internal Medicine, 7(136), 641-651.

Straton, J. A., Sutherland, G. J., & Hyndman, J. C. (1995). Cervical cancer screening for hospital inpatients: Report of an intervention study. Australian Journal of Public Health, 19(3), 288-293. doi:10.1111/j.1753-6405.1995.tb0045.x

Subramanian, S., Trogdon, J., Ekwueme, D. U., Gardner, J. G., Whitmire, J. T., & Rao, C. (2010). Cost of cervical cancer treatment: Implications for providing coverage to low-income women under the Medicaid expansion for cancer care. Womens Health Issues, 20(6), 400-405. doi:10.1016/jwhi.2010.07.002

Trimble, C. L., Richards, L. A., Wilgus-Wegweiser, B., Plowden, K., Rosenthal, D., & Klassen, A. (2004). Effectiveness of screening for cervical cancer in the inpatient hospital setting. Obstetrics and Gynecology, 103(2), 310-316. doi:10.1097/01.AOG.0000109209

WHO/ICO Information Centre (2010). Human papillomavirus and related cancers in world. Summary report 2010. Retrieved February 3, 2013, from http://who.int/hpvcentre

OBG Nursing