Increasing awareness, training in and use of the left lateral cervical screening position in primary care: Increasing choice and supporting implementation of clinical guidelines

 

Funding

National Institute for Health and Care Research (NIHR) Research for Patient Benefit (RfPB) Ref. NIHR 204301

What is the Research Question?

Will providing people eligible for screening with information about their screening choices, and supporting practices to implement the new position improve uptake and experience of cervical screening?

What is the problem?

Cervical screening or smear tests are important to detect a virus or cell changes that may lead to cancer. People with a cervix are invited for testing from age 25-64, and later when previous abnormal results are found. Traditional testing requires the patient to lie on their back with knees bent up and apart so the clinician can take a swab sample. Some people report they find the test degrading, embarrassing, anxiety provoking and uncomfortable. Also, people who have experienced sexual trauma report the test makes them feel vulnerable, and in women who for cultural reasons have genital circumcision, exposing their body parts leads to embarrassment and anxiety. These issues contribute to the steadily reducing numbers attending screening.

In 2020 national guidelines included the new left lateral test position (LLTP), and all people who attend for cervical screening should now be offered both positions. In the new position the patient lies on their left side, similar to the ‘recovery position’ with their legs slightly apart. The LLTP is as effective, is less exposing and may be more comfortable, which may encourage more people to attend screening. However, our research has shown that patients are not aware of this position and clinicians are not offering it.

What is the aim of the research?

To investigate whether providing people eligible for screening with information about their screening choices, and supporting practices to implement the new position improves uptake and experience of cervical screening.

How will this be achieved?

We will evaluate how introducing the new position works in practice, asking what works, for whom, how and why?

There will be three phases (P):

P1: We will undertake co-design workshops to create information about screening choice, ensuring the language is accessible and acceptable, and to determine how people would like to receive information from their practice. We will investigate any challenges to implementing the new position in practice

P2: Evidence review and focus groups to develop an understanding of how the new position may work in practice

P3: Working with 13 GP sites over about a 9-month period we will test whether supporting them to inform patients of their screening choices, and helping clinicians to offer the new position, encourages more people to be screened, choose their position and improves patient experience. We will collect data from the practice regarding screening uptake and position before we start the study, and then again at the end to see how our research influences screening in practice. We will also survey attendees to understand their experience and interview some staff and patients to understand if/how/why the test works in practice.

Who is leading the Research?

Professor Nicola Walsh, Professor of Knowledge Mobilisation and Musculoskeletal Health at the University of the West of England, Bristol

Further Information:

CI Email: Nicola.Walsh@uwe.ac.uk

For more information or to get involved in this project, please contact bnssg.research@nhs.net.

The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.