Management of women with minor abnormalities of the cervix detected on screening: a qualitative study

Objective: To examine the consistency of decisions by pathology staff and g eneral practitioners in managing women in whom minor cervical abnormalities are detected by screening, with current National Health and Medical Resear ch (NHMRC) Council guidelines, and to look at reasons for inconsistencies. Design: Qualitative interview study. Participants: 14 pathology staff (12 pathologists and two cytoscientists) f rom 10 of the 17 laboratories providing cervical cytology services in Victo ria, and a sample of 22 GPs from metropolitan and rural locations in Victor ia. Main outcome measures: Comparison of management practice with NHMRC guideli nes; reasons for current decision-making practice. Results: Most pathologists provided more cautious recommendations for minor abnormalities of the cervix than the NHMRC recommendations in all reportin g categories except human papillomavirus. Pathologists had concerns about t he appropriateness of the NHMRC recommendations, particularly for glandular atypia, lack of an endocervical component and inflammatory smears, where t hey believed that the NHMRC recommendations were not well supported by evid ence. GPs generally followed the recommendations of their laboratories. Med icolegal concerns were a major influence on clinical decisions for both pat hologists and GPs, and have contributed to the development of cautious mana gement practice. Reporting and management practice of pathologists and GPs reflects the ambiguity of minor cervical abnormalities that the NHMRC guide lines fail to highlight. Conclusion: Many pathologists and GPs are reluctant to follow NHMRC guideli nes because they:believe they are inadequate for some minor cervical abnorm alities. The cervical screening guidelines should be reviewed according to the NHMRC guidelines for developing clinical practice guidelines, to promot e consistent practice based on an up-to-date, accurate evidence base.