Date of Award

Spring 5-23-2015

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Mary Barger, PhD, MPH, FACNM

Second Advisor

Kathy James, DNSc, APRN, FAAN

Abstract

The purpose of this evidence-based project is to decrease unnecessary colposcopy referrals using provider education and user friendly tools. This is accomplished by increasing utilization of the 2012 American Society for Colposcopy and Cervical Pathology (ASCCP) Guidelines at a Military Treatment Facility Family Practice Clinic. Despite clear cervical cancer screening guidelines, nationwide, women are continuing to have unnecessary Pap testing regardless of HPV status. Over screening can result in an increase in false positive results, leading to rising healthcare costs, additional office visits, and stress to the patient from procedures that yield little useful information or decrease in morbidity. Although consensus guidelines and algorithms detailing screening guidelines, management and follow up recommendations have been published by the ASCCP, providers are still performing unnecessary colposcopies, biopsies, and repeat Pap tests prior to recommended follow up. This project measured provider’s knowledge and comfort level with guidelines using a survey on frequency of screening, use of co-testing with HPV, management of abnormal cytology results, and barriers to implementation in the setting. Educational sessions were developed based on survey results and conducted using multiple tools to help providers apply the algorithms for abnormal cytology algorithms including a web-based tool, mobile app, and simplified one-page algorithm. However, data collection and delivery of educational session was unable to be implemented due to multiple barriers at the site including staff turnover, deployments of key personnel and stakeholders, changes to IRB approval, and competing needs, resources, and priorities at higher administrative levels.

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