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  • EP369/#581  Impact of focused interventions to enhance cervical cancer screening uptake at tertiary care hospitals in India: a multicentric study

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AS16. Screening/Early detection
EP369/#581  Impact of focused interventions to enhance cervical cancer screening uptake at tertiary care hospitals in India: a multicentric study
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  1. Neerja Bhatla1,
  2. Rakhi Rai1,
  3. Shachi Vashist1,
  4. Poonam Shivkumar2,
  5. Latha Balasubramani3,
  6. Shalini Rajaram4,
  7. Saritha Shamsunder5,
  8. Seema Singhal1,
  9. Jyoti Meena1,
  10. Latika Chawla4,
  11. Anju Singh1,
  12. Sarita Kumari1,
  13. Swati Tomar1,
  14. Archana Mishra5,
  15. BS Garg6 and
  16. Rohini Sehgal1
  1. 1All India Institute of Medical Sciences, Obstetrics and Gynaecology, New Delhi, India
  2. 2Mahatma Gandhi Institute of Medical Sciences, Obstetrics and Gynaecology, Wardha, India
  3. 3GKNM Hospital, Oncology, Coimbatore, India
  4. 4AIl India Institute of Medical Sciences, Rishikesh, Obstetrics and Gynecology, Rishikesh, India
  5. 5VMMC and Safdarjung Hospital, Obstetrics and Gynaecology, New Delhi, India
  6. 6Mahatma Gandhi Institute of Medical Sciences, Community Medicine, Wardha, India

Abstract

Introduction Cervical cancer screening coverage does not meet WHO elimination targets even at tertiary institutes in India. This interventional study assessed the impact of simple quality improvement (QI) tools in five tertiary care institutes where a situational analysis was previously done.

Methods This WHO-SEARO supported multicentric study was conducted between August 2021 and May 2022. Root cause analysis using Fishbone (4Ps) and seven PDSA (Plan-Do-Study-Act) cycles were undertaken.

Results Root-cause analysis showed that despite Policy, Procedure- and People-related factors were barriers to adequate screening (figure 1). PDSA-1 (training of healthcare professionals) increased the mean screening rate from baseline 24.8% to 28.8% (range 16.8–33.0%). PDSA-2 (poster display in clinics) had no impact (28.1%; range 16.4–36.2%). PDSA-3 (instant reminders using tags over cards) led to marginal improvement (31.0%; range 26.9–70%). PDSA-4 (facilitating VIA in each room) actually reduced screening rate (22.7%; range 17.3–30.9%) due to poor compliance in busy clinics. PDSA-5 (creation of a dedicated screening facility by paramedical workers (PMWs) further increased the screening rate to 43.6% (range 25–47.7%). PDSA-6 (daily WhatsApp reminders to HCPs) had variable impact (43%; range 17.9–90%). However, sustenance was not feasible, as PMWs were posted for other clinical services and also separate facility interrupted the patient’s flow. PDSA-7 (increased supply of kits along with counselling at entry point and stamp application on card) could increase the rates to 52.8% (range 35–98%). (figure 2)

Conclusion/Implications Sensitization and training of healthcare professionals and paramedical workers is essential. Novel, contextual interventions can improve screening uptake even in tertiary hospitals in developing countries.

Abstract EP369/#581 Figure 1
Abstract EP369/#581 Figure 1

Root cause analysis: FISH BONE CHART (4Ps)

Abstract EP369/#581 Figure 2
Abstract EP369/#581 Figure 2

Mean screening rates after each focused intervention

https://doi.org/10.1136/ijgc-2023-IGCS.420

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