Promoting screening for cervical cancer: Realising the potential for recruitment by general practitioners

This paper explores the potential for general practitioners to promote screening for cervical cancer and describes one example of an effective general practitioner-based (GP-based) programme to improve community screening rates. The GP-based programme was designed to improve general practitioners' involvement in recruiting women in their communities to have Pap smears. The aim was to raise doctors' awareness of the fact that many women are not adequately screened, to encourage them to consider why these women are not being recruited, to assist them to develop strategies to overcome these problems, and to support them in the use of these strategies by providing information and resources, feedback on performance, and peer support. The effectiveness of the GP-based programme was assessed as part of a multi-centre trial to compare the differential effectiveness of three community-based strategies to promote screening for cervical cancer: a television campaign, a television campaign combined with personally addressed letters sent to all women in the community, and a television campaign combined with the GP-based programme. Each intervention was delivered to three postal regions in New South Wales, Australia, and time-series data on Pap smear rates were obtained. Three control regions were included for comparison. Of all three strategies, the combined television campaign and GP-based programme had the most potential, with up to an additional 8% of previously unscreened women being screened during each quarter of the combined television campaign and GP-based programme. This compares with screening of 2-4% of previously unscreened women in association with television combined with letters, and only 1-3% of previously unscreened women when television was used alone. However, the impact of the GP-based programme was highly variable. This variation in effectiveness points to a need for further research to determine the general practitioner, community and programme factors associated with programme success.