Nursing for Women's Health

A Multicomponent, Team-Based Quality Improvement Project for Improving Cervical Cancer Screenings in Primary Care

To increase cervical cancer screening (CCS) adherence by 10% over 4 months and improve provider knowledge and use of evidence-based guidelines, as measured by the Evidence-Based Medicine Questionnaire. An evidence-based, 10-min slide presentation on improving CCS was delivered to clinicians, medical assistants, and front desk staff at internal medicine offices. Cervical cancer is highly curable, with a 5-year relative survival rate of 91% when detected at a localized stage. In 2023, a multisite primary care group in northeast Massachusetts reported a CCS adherence rate of 60.5%, well below the national average of 73.9%. Ninety-seven staff members across six sites were eligible to participate, including 40 clinicians (18 physicians, 22 advance practice providers), 43 medical assistants, and 14 front desk staff. All 40 clinicians participated, but medical assistants and front desk staff were not surveyed. Using a pretest and posttest design with convenience sampling, internal medicine clinicians completed the Evidence-Based Medicine Questionnaire 1 month before and 3 months after watching the slide presentation. CCS adherence increased from 58% in June 2024 to 62% in October 2024, a 4% gain. The number of Papanicolaou smears performed also rose by 4%, from 618 in 2023 to 640 in 2024. With the highest possible Evidence-Based Medicine Questionnaire score of 205 representing high knowledge of evidence-based guidelines, pretest scores (n = 9) ranged from 122 to 194 (mean = 157) and posttest scores (n = 8) ranged from 125 to 198 (mean = 166), suggesting a modest improvement in knowledge and application of evidence-based guidelines with fewer perceived barriers. Continued use of evidence-based practices may further improve CCS adherence rates across this multisite primary care group, bringing them closer to national benchmarks.

Increasing Referral Acceptance for Women’s Health Services Among Hispanic Women

To evaluate the effect of an individualized educational intervention on women's health referral acceptance rates among Hispanic women. Quality improvement (QI) project. Barriers to cervical cancer screening among Hispanic women include a lack of access to women's health services and a lack of knowledge related to cervical cancer risk factors. Primary care providers at two medical clinics in eastern Pennsylvania did not routinely discuss cervical cancer risk factors, provide well-woman care, or perform cervical cancer screening during office visits. This gap in preventive care provided an opportunity for quality improvement. A convenience sample of 65 self-identified Hispanic women presenting for primary care office visits. Each consenting participant received a one-on-one education session lasting 5 to 10 minutes regarding individual risk factors for cervical cancer. Each woman was offered a referral for a well-woman examination, with or without cervical cancer screening. Data collection included the participant's response to the offered referral. The majority of participants who received the educational intervention (96.9%, n = 63) accepted referrals for women's health services. An educational intervention discussing individual cervical cancer risk factors was associated with increased women's health referral acceptance rates among Hispanic women.

Use of a Standardized Tool to Identify Women at Risk for Hereditary Breast and Ovarian Cancer

To increase rates of identification and genetic counseling referral for women at risk of hereditary breast and ovarian cancer (HBOC). Evidence-based practice improvement initiative. Private suburban obstetric and gynecologic (OB/GYN) practice in Tennessee with no standardized process for HBOC risk assessment or referral to genetic services. Provider-led women's health care teams delivering well-woman care for women ages 18 years and older. We implemented the use of a standardized familial risk assessment tool and clinical decision-making algorithm. Preimplementation and postimplementation risk identification and genetic services referral rates were measured, as was clinicians' compliance with using the risk assessment tool. The aim of the initiative was to increase identification and referral rates by 25 percentage points. Women at risk of HBOC in the postimplementation group were 25.9 times more likely to be identified as being at risk (OR = 25.88, 95% confidence interval [10.78, 62.14]) and 31.5 times more likely to be offered referral to genetic counseling (OR = 31.50, 95% CI [13.37, 74.22]) compared with those in the preimplementation group. Rates of risk identification and referral to genetic counseling for women at risk of HBOC improved by 58.2 and 69.3 percentage points, respectively, surpassing the aims of this initiative and showing statistical significance of p < .001 for both indices. The use of a standardized risk assessment tool and process for HBOC risk identification and genetic referral resulted in a significant increase in the identification and referral of women at risk in this setting. Early identification of women with HBOC is a crucial first step in increasing the use of enhanced screening and interventions that can reduce HBOC-associated cancer morbidity and mortality.

The Potential of Human Papillomavirus Self-Collection Testing to Improve Cervical Cancer Screening Among Women Living With HIV

In this short review we summarize two recent studies in which researchers assessed the validity and acceptability of human papillomavirus (HPV) self-collection testing among U.S. women living with HIV. The first study evaluated both the performance and acceptability of the test, and the second study explored the perspectives and needs regarding its potential implications. Clinic-based self-collection HPV testing among women living with HIV demonstrated good sensitivity, moderate specificity, and high acceptability compared to clinician-collected tests. It is imperative for nurses to stay informed about emerging cervical cancer screening test methods and to be prepared for their future implications.