Interventions targeted at women to encourage the uptake of cervical screening

 

Abstract

Background

World-wide, cervical cancer is the second most common cancer in women. Increasing the uptake of screening, alongside increasing informed choice is of great importance in controlling this disease through prevention and early detection.

Objectives

To assess the effectiveness of interventions aimed at women, to increase the uptake, including informed uptake, of cervical cancer screening.

Search methods

We searched the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Issue 1, 2009. MEDLINE, EMBASE and LILACS databases up to March 2009. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field.

Selection criteria

Randomised controlled trials (RCTs) of interventions to increase uptake/informed uptake of cervical cancer screening.

Data collection and analysis

Two review authors independently abstracted data and assessed risk of bias. Where possible the data were synthesised in a meta-analysis.

Main results

Thirty-eight trials met our inclusion criteria. These trials assessed the effectiveness of invitational and educational interventions, counselling, risk factor assessment and procedural interventions. Heterogeneity between trials limited statistical pooling of data. Overall, however, invitations appear to be effective methods of increasing uptake. In addition, there is limited evidence to support the use of educational materials. Secondary outcomes including cost data were incompletely documented so evidence was limited. Most trials were at moderate risk of bias. Informed uptake of cervical screening was not reported in any trials.

Authors' conclusions

There is evidence to support the use of invitation letters to increase the uptake of cervical screening. There is limited evidence to support educational interventions but it is unclear what format is most effective. The majority of the studies are from developed countries and so the relevance to developing countries is unclear.

 

Plain language summary

Invitations and probably educational interventions increase the uptake of Pap smears

Cervical cancer is the second most common cancer world-wide. Increasing the uptake of screening is of great importance in controlling this disease through early detection and treatment of pre-cancerous changes before malignancy evolves. Methods of encouraging women to undergo cervical screening include invitations, reminders, education, message framing, counselling, risk factor assessment, procedures and economic interventions. These were all examined in this review. Evidence supports the use of invitations, and to a lesser extent, educational materials. It is likely other methods are advantageous, but the evidence is not as strong. Further research is required.

 

摘要

背景

鼓勵女性接受子宮頸癌檢查的方式

子宮頸癌是全世界第三大癌症。增加篩檢接受率與同時增加知情選擇(informed choice)，對於預防和早期發現來控制這種疾病，是非常重要的。

目標

評估增加子宮頸癌篩檢率及根據通知而接受子宮頸癌篩檢的介入方式的效果。

搜尋策略

我們搜尋了23個電子資料庫(直到2000年3月)，搜尋時沒有語言的限制。

選擇標準

增加接受/根據通知而接受子宮頸癌檢查之介入方法的隨機對照試驗(randomised controlled trials；RCTs)或半隨機對照試驗。

資料收集與分析

由2名研究回顧者獨立地摘錄與研究特徵和品質有關的數據。如果有可用的數據，計算其相對風險和95% CI，並且針對異質性進行卡方檢定。

主要結論

本回顧共包含35項研究(27項隨機對照試驗及8項半隨機對照試驗)。研究間的異質性限制了數據的合併統計。然而整體而言，邀請方式似乎是增加女性接受篩檢有效方法。此外，只有有限的證據支持使用教材。所納入的研究之數量和品質，限制了其他介入方法之有效性分析。所有研究都沒有研究根據通知而接受子宮頸癌篩檢的結果。

作者結論

有一些證據支持使用邀請函來增加女性接受子宮頸癌檢查的人數。支持教育介入的證據有限，但是還不清楚哪種形式的教育最有效。大部分的研究是來自已開發國家，因此與開發中國家的相關性仍然不明。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

邀請和教育介入也許可以增加女性接受子宮頸抹片的比例。本回顧探討了鼓勵女性進行子宮頸癌檢查的方法，包括邀請、提醒、教育、訊息架構、諮詢、風險因素評估、程序和經濟介入。證據支持使用邀請的方式，有限的證據建議使用教材。其他方法也可能是有利的，但是證據並不那麼確切。還需要進一步研究。