Scandinavian Journal of Primary Health Care

Communicating abnormal cervical cancer screening results – a focus group study with general practitioners in Norway

A gradual transition from cytology-based screening to Human Papillomavirus (HPV) testing within the cervical cancer screening program has resulted in new routines for follow-up, and new challenges for communication of abnormal test results. General practitioners (GPs) have an important role in the screening program, as they are the primary performers of the screening test, they communicate test results to patients and refer them to a specialist if necessary. The study explores what consequences the introduction of HPV testing in the cervical cancer screening programme has for GPs' professional practice and communication with patients. Qualitative focus group study including 32 GPs in Central Norway who conduct screening tests within the cervical cancer screening programme. The overall concern of the GPs was to communicate abnormal test results in a way that ensured appropriate follow-up, without causing unnecessary worry. Staying updated on revised screening guidelines and maintaining their role as medical experts when communicating results to patients could be challenging. GPs shared the responsibility for follow-up after an abnormal result between themselves, the women, and the screening programme. Reciprocal familiarity between GP and patient guided decisions about what and how to communicate, and how to balance the shared responsibility. GPs used their professional judgement to assess patients' informational needs and tailored information accordingly. GPs manage the challenges of communicating abnormal screening results by sharing responsibility and using their professional judgement. Strengthening support and communication tools may enhance their role in the screening programme.

Direct access from general practice to transvaginal ultrasound for early detection of ovarian cancer: a feasibility study

To investigate the feasibility of providing general practitioners (GPs) direct and fast referral access to transvaginal ultrasound (TVUS). A prospective cohort study. A total of 232 Danish general practices in parts of the Central Denmark Region. Women aged ≥40 years who consulted their GP for vague and non-specific symptoms ( The feasibility assessment included the GPs' referral rate, indications for referral, management of test results, and findings from TVUS. A total of 479 women were referred to TVUS. The examinations revealed abnormalities in 104 (21.7%) women. Additional investigations were needed in 68 (14.2%) women of whom seven (1.5%) underwent major surgery. No case of ovarian cancer was diagnosed during the study period or the 6-month follow-up. However, three (0.6%) women with an abnormal transvaginal ultrasound were diagnosed with urogynecological cancer; this yielded a PPV of 4.4% (95% confidence interval: 1.5-12.2) and an NPV of 100.0% (95% confidence interval: 96.7-100.0) for urogynecological cancer. Providing GPs with direct access to transvaginal ultrasound was feasible; 80% of the investigated women were referred back to the GP, 14% were further investigated, 0.6% were diagnosed with urogynecological cancer, and 1.5% had major procedures performed without complications. Direct access to TVUS could be an important pathway to ensure fast evaluation of women presenting with vague non-specific symptoms of potential ovarian cancer. Future studies should explore the patient experience, cancer outcomes, and health economics issues.KEY POINTS

Do they cope or mope? A survey of GPs’ experiences with the changes in the Norwegian Cervical Cancer Screening Programme

To explore Norwegian general practitioners' (GPs) experiences with the changes in the cervical cancer screening programme and to uncover which aspects of the programme they find most challenging. We conducted an electronic cross-sectional survey. Norwegian GPs were invited to participate in the survey between February and September in 2020. One hundred and fifty-five of 429 invited Norwegian GPs responded. Self-reported measures were used to analyse GPs experiences and beliefs related to the screening programme. Most GPs did not find it particularly challenging to keep up with the changes in the screening programme, regardless of whether they came from areas with HPV-based or cytology-based cervical cancer screening implemented. Challenges concerning the follow-up of patients after an abnormal test were a frequently reported issue. We did not find any differences in how often GPs were uncertain of the follow-up of an abnormal test result in areas with HPV-based compared to cytology-based screening. The implementation of HPV-based cervical cancer screening in women 34-69 years does not seem to have affected how challenging the GPs perceive the screening programme.Key PointsHow Norwegian general practitioners (GPs) keep up with changes in the Norwegian Cervical Cancer Screening Programme (NCCSP) has not been assessed previously.Most GPs did not find it particularly challenging to keep up with changes in the NCCSP regardless of whether they belonged to an area of HPV-based or cytology-based screening.The follow-up of patients with an abnormal test result was one of the main challenges reported by the GPs.