Management of women with minor abnormalities of the cervix detected on screening: a qualitative study

Abstract

To examine the consistency of decisions by pathology staff and general practitioners in managing women in whom minor cervical abnormalities are detected by screening, with current National Health and Medical Research (NHMRC) Council guidelines, and to look at reasons for inconsistencies. Qualitative interview study. 14 pathology staff (12 pathologists and two cytoscientists) from 10 of the 17 laboratories providing cervical cytology services in Victoria, and a sample of 22 GPs from metropolitan and rural locations in Victoria. Comparison of management practice with NHMRC guidelines; reasons for current decision-making practice. Most pathologists provided more cautious recommendations for minor abnormalities of the cervix than the NHMRC recommendations in all reporting categories except human papillomavirus. Pathologists had concerns about the appropriateness of the NHMRC recommendations, particularly for glandular atypia, lack of an endocervical component and inflammatory smears, where they believed that the NHMRC recommendations were not well supported by evidence. GPs generally followed the recommendations of their laboratories. Medicolegal concerns were a major influence on clinical decisions for both pathologists and GPs, and have contributed to the development of cautious management practice. Reporting and management practice of pathologists and GPs reflects the ambiguity of minor cervical abnormalities that the NHMRC guidelines fail to highlight. Many pathologists and GPs are reluctant to follow NHMRC guidelines because they believe they are inadequate for some minor cervical abnormalities. The cervical screening guidelines should be reviewed according to the NHMRC guidelines for developing clinical practice guidelines, to promote consistent practice based on an up-to-date, accurate evidence base.