Cancer Screening: Provider Assessment and Feedback — Cervical Cancer
Findings and Recommendations
The Community Preventive Services Task Force (CPSTF) recommends provider assessment and feedback interventions on the basis of sufficient evidence of effectiveness in increasing screening for cervical cancer by Pap test.
The full CPSTF Finding and Rationale Statement and supporting documents for Cancer Screening: Provider Assessment and Feedback — Cervical Cancer are available in The Community Guide Collection on CDC Stacks.
Intervention
Provider assessment and feedback interventions both evaluate provider performance in delivering or offering screening to clients (assessment) and present providers with information about their performance in providing screening services (feedback). Feedback may describe the performance of a group of providers (e.g., mean performance for a practice) or an individual provider, and may be compared with a goal or standard.
About The Systematic Review
The CPSTF finding is based on evidence from a Community Guide systematic review published in 2008 (Sabatino, et al., search period through September 2004) combined with more recent evidence (search period 2004 – October 2008). The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to cancer prevention and control.
The effectiveness of provider-directed interventions was determined by considering evidence across all three cancer screening sites combined, as long as there were not differences in effectiveness by screening test. This was done because provider behavior was thought to be less influenced than client behavior by the nature of screening tests.
Study Characteristics
- Completed screening outcomes were assessed by medical record review.
- Provider screening performance was assessed by providers auditing charts of their own patients or another provider’s patients, via computer search, or chart review by researchers.
- Feedback was provided concerning individual provider performance, or both individual and group provider performance.
- Feedback received by providers varied from a single occurrence to regular intervals.
- Studies of completed screening were conducted in urban settings in the U.S. and the United Kingdom and included both trainee and nontrainee physicians.
Summary of Results
The review included nine studies that assessed intervention effectiveness for breast, cervical, and colorectal cancers.
- Screening for breast, cervical or colorectal cancer: median increase of 13.0 percentage points (interquartile interval: 5.5 to 21.8 percentage points; 13 study arms).
- Completed cervical screening by Pap test: estimated effects ranged from a 4.0 to 29.5 percentage point increase (4 study arms)
Summary of Economic Evidence
The updated search for evidence included studies about breast, cervical, or colorectal cancer screening. Only one study about colorectal cancer screening qualified for the review. Monetary values are presented in 2009 U.S dollars.
- The estimated cost of increasing screening for colorectal cancer among military veterans was $1,074 per additional screening.
Implementation Considerations and Resources
- While assessment and feedback interventions showed positive effects in both trainee and nontrainee physician populations, there is some evidence to suggest trainees are more responsive.
- Reported barriers to implementation included the following:
- Potential burdens on practices or clinic staff to complete audits and prepare and provide feedback.
- Possible sensitivity of some providers to the source of evaluation. Trained physicians may be sensitive to evaluation and criticism from other physicians or insurance companies.
Crosswalks
Healthy People 2030 includes the following objectives related to this CPSTF recommendation.