PROMOTING SCREENING FOR CERVICAL-CANCER - REALIZING THE POTENTIAL FORRECRUITMENT BY GENERAL-PRACTITIONERS

This paper explores the potential for general practitioners to promote screening for cervical cancer and describes one example of an effecti ve general practitioner-based (GP-based) programme to improve communit y screening rates. The GP-based programme was designed to improve gene ral practitioners' involvement in recruiting women in their communitie s to have Pap smears. The aim was to raise doctors' awareness of the f act that many women are not adequately screened, to encourage them to consider why these women are not being recruited, to assist them to de velop strategies to overcome these problems, and to support them in th e use of these strategies by providing information and resources, feed back on performance, and peer support. The effectiveness of the GP-bas ed programme was assessed as part of a multi-centre trial to compare t he differential effectiveness of three community-based strategies to p romote screening for cervical cancer: a television campaign, a televis ion campaign combined with personally addressed letters sent to all wo men in the community, and a television campaign combined with the GP-b ased programme. Each intervention was delivered to three postal region s in New South Wales, Australia, and time-series data on Pap smear rat es 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 prev iously unscreened women being screened during each quarter of the comb ined television campaign and GP-based programme. This compares with sc reening of 2-4% of previously unscreened women in association with tel evision combined with letters, and only 1-3% of previously unscreened women when television was used alone. However, the impact of the GP-ba sed programme was highly variable. This variation in effectiveness poi nts to a need for further research to determine the general practition er, community and programme factors associated with programme success.