Woman-centered Cervical Screening: Identifying Women's Preferences and Factors Related to Their Preferences in Cervical Cancer Screening

Abstract

Objectives This dissertation had two overarching objectives: 1. To determine how stakeholders perceive women’s preferences for cervical screening modalities. 2. To understand methods to measure women’s cervical screening preferences, to inform the development and testing of a person-centered, evidence-informed approach to preference-elicitation. Methods The overarching conceptual framework was the Ottawa Decision Support Framework. The first objective was addressed by interview studies with (1) guideline developers and program managers and (2) health professionals and women considering screening. This was complemented by a systematic review of quantitative, qualitative and mixed-methods studies of women’s cervical screening preferences, using the Grading of Recommendations, Assessment, Development, and Evaluation approach to developing preference-based recommendations. This approach was also used in a systematic review of methods to elicit women’s preferences, addressing the second objective. These findings led to the development and field testing of a preference-elicitation tool using International Patient Decision Aid Standards criteria, and the development of a protocol for a population-based study of women’s preferences. iv Results Objective 1 Experts disagree about whether there is enough evidence to include alternative modalities in cervical screening programs. Women and health care professionals do not recognize that women face a choice to participate in cervical screening. A narrative synthesis of relevant literature presented challenges in aggregating preferences across diverse study objectives, designs, and contexts. Objective 2 Preference-elicitation approaches for cervical screening are heterogenous in design and rigour. I therefore developed and field tested a tool to elicit women’s preferences, which demonstrated that women found the tool helpful to identify their preferences. I then propose a study that uses multiple methods to apply the tool more broadly. Conclusions Synthesized preferences data might not be the optimal approach to incorporate preferences into cervical screening guidelines. A tool grounded in shared decision-making can help women identify their informed, values-based screening preferences.