Cervical cancer is a major issue; it is the second most prevalent type of cancer experienced by women, and it is associated with increased mortality (Perks, Algoso & Peters, 2018; Wentzensen et al., 2017). Consequently, cervical cancer prevention is particularly important, and one of the most effective strategies in this regard is routine screening (Perks et al., 2018; US Preventive Services Task Force, 2012). Nowadays, sufficient evidence exists to develop evidence-based recommendations on the topic (Haas et al., 2015; Wentzensen et al., 2017). For example, the US Preventive Services Task Force (2012) has produced a recommendation, which is going to be updated soon. The current version is employed in clinical settings by various providers, including nurse practitioners, to offer advice and determine appropriate screening practices (Haas et al., 2015). However, a recent investigation by Haas et al. (2015) demonstrates that even though providers are typically familiar with existing recommendations, they might not always adhere to them.
Consequently, the problem of guideline adherence seems to be worth investigating, and it is connected to the causes of non-compliance, which, as shown by Haas et al. (2015) are rather varied. By examining non-compliance in a specific setting, a nurse can promote the adoption of evidence-based guidelines, which is an appropriate topic for a DNP project (Melnyk, Fineout-Overholt, Stillwell, & Williamson, 2009; Stillwell, Fineout-Overholt, Melnyk, & Williamson, 2010). The problem statement for such efforts can be phrased as follows: in order to improve the use of cervical cancer screening recommendations, advance the quality of care, and promote the safety of the patients who are at risk of cervical cancer, it is necessary to investigate and address the causes of non-compliance.
The etiology of the problem of non-compliance is multifaceted, which is demonstrated by the nursing and medical literature dedicated to the topic. An important factor that can cause non-compliance is patient preferences, which may differ from the recommendations (Gerend, Shepherd, Kaltz, Davis, & Shepherd, 2017; Haas et al., 2015). The issue may be connected to the fact that many practitioners report the lack of time and tools for the discussion of screening with patients (Haas et al., 2015). Therefore, patient preferences might be associated with insufficient knowledge on the topic, and this aspect of the problem can also indicate the need for effective patient education. Moreover, a variety of socioeconomic barriers are also present for women (Perks et al., 2018). Thus, the topic of patient preferences is multidimensional and indicates several layers of potential causes of non-compliance.
Some organizational issues are also encountered by providers; in particular, conflicting measurement criteria were mentioned (Haas et al., 2015). Furthermore, provider-related causes may also be problematic; for example, variable training may be a concern (Wentzensen et al., 2017). Moreover, in the study by Haas et al. (2015), 14% of the respondents reported disagreeing with existing recommendations, and 21% expressed concerns about potential malpractice, which resulted in non-compliance. The authors conclude that there is an ongoing controversy with respect to the guidelines by the US Preventive Services Task Force (2012), which limits their application in practice.
In summary, given the significance of cervical cancer prevention, the non-compliance with evidence-based guidelines may be problematic. Furthermore, the investigation of the reasons for non-compliance does identify some issues, including inefficient patient education and confounding measurement criteria. The present paper demonstrates that the causes for the problem of non-compliance are numerous, and some potential solutions also tend to emerge from modern literature. This information can be employed by a nurse to improve the use of evidence-based recommendations in their clinical settings.
Gerend, M., Shepherd, M., Kaltz, E., Davis, W., & Shepherd, J. (2017). Understanding women’s hesitancy to undergo less frequent cervical cancer screening. Preventive Medicine, 95, 96-102.
Haas, J. S., Sprague, B. L., Klabunde, C. N., Tosteson, A. N., Chen, J. S., Bitton, A.,… Harris, K. (2016). Provider attitudes and screening practices following changes in breast and cervical cancer screening guidelines. Journal of General Internal Medicine, 31(1), 52-59.
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Perks, J., Algoso, M., & Peters, K. (2018). Nurse practitioner (NP) led care: Cervical screening practices and experiences of women attending a women’s health centre. Collegian, 2018, 1-7.
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice. American Journal of Nursing, 110(3), 58-61. Web.
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Wentzensen, N., Massad, L. S., Mayeaux Jr, E. J., Khan, M. J., Waxman, A. G., Einstein, M. H.,… Chelmow, D. (2017). Evidence-based consensus recommendations for colposcopy practice for cervical cancer prevention in the United States. Journal of Lower Genital Tract Disease, 21(4), 216-222.