Step 4: Address awkwardness and discomfort as a barrier to screening
This section covers the following steps:
|Step 4.1 Discuss self-collection with eligible people who refuse to have a clinician-collected sample taken|
|Step 4.2 Make the cervical screening experience as comfortable as possible|
|Step 4.3 Address the bowel cancer screening ‘yuck’ factor|
In 2019, the Australian Cervical Cancer Foundation surveyed 1,005 women, which found that:
- 37.1% of women may be put off having a Cervical Screening Test because they find it uncomfortable
- 32.3% of women may be put off having a Cervical Screening Test because they find it awkward
- more than 70% of women did not know how often they should have a Cervical Screening Test.
Get a copy of a printable infographic of the Australian Cervical Cancer Foundation’s findings.
Step 4.1 Discuss self-collection with eligible people who refuse to have a clinician-collected sample taken
Offering self-collection of vaginal samples for HPV testing can be a powerful way to increase the participation in the National Cervical Screening Program by women who have previously refused screening.
Case study: The Victorian Self-Collection Pilot Project
The Victorian Self-collection Pilot Project was a 12-month project conducted in three health services that support women experiencing disadvantage from a range of backgrounds.
The project evaluation report found that:
- offering self-collection in a clinical setting was largely embraced by under-screened women
- a participation rate of 85.7% was achieved in the pilot
- self-collection was an acceptable and welcome alternative to a practitioner-collected cervical screening test
- under-screened women are likely to be experiencing multiple circumstantial and sociocultural barriers to cervical screening that are unlikely be overcome simply by the introduction of a new test
- health care providers need to have strong cultural competency and a good understanding of their local communities.
Self-collection of vaginal samples for HPV testing is available to women who are 30 years or older, and have either:
- never had a Cervical Screening Test (or Pap test)
- are at least two years overdue for cervical screening.
Module 3 provides guidance on how to identify patients who meet the criteria for self-collection.
- The following tips can help make the screening experience comfortable for patients22:
- Explain what screening involves: Use visual aids to assist, if appropriate (e.g. brochures, anatomical model, speculum and sampling brushes).
- Ask patients if they would like to insert the speculum themselves.
- Provide instructions on deep breathing techniques.
- Consider prescribing a short course of vaginal oestrogen cream for post-menopausal women, if appropriate (e.g. patients with dyspareunia or discomfort due to vaginal atrophy. Treatment needs to be prior to the appointment for screening).23
- The Australian Cervical Cancer Foundation offers the following resources:
Success in practice: Providing trauma-informed cervical screening
ACON’s CheckOUT clinic provides HIV/STI and cervical screening clinics for the LGBTIQ+ community.
Bec Cerio, Cancer Programs Officer at ACON, shares insights about the CheckOUT Clinic approach:
“CheckOUT Clinic runs on a model of trauma informed care, which we know is important for our communities. It is particularly important for trans and gender diverse patients who might experience dysphoria around genitals, as well as for patients with sexual trauma.” “Given many members of our community find cervical screening difficult we provide a lot of tips on ‘Getting through your cervical screening test’.
“We let patients know that they can use their phone to zone out during the procedure, and we also give patients the opportunity, via our registration form, to tell us if they would like:
- the nurse to stand slightly to the side of the bed
- to be propped up a little rather than lie down
- to nominate a Safe word to stop the procedure entirely
- to use a tap on the bed as a non-verbal ‘slow down’ signal
- to self-insert the speculum
- the nurse to go into detail about what they’re doing or stick to the basics (i.e. just tell you when they start and finish)
- the nurse to make small talk or let you drift off
- quiet time afterwards, on their own or with a peer.
We also provide a letter that people can give to their GP when requesting a cervical screening test. The letter allows the person to alert their GP that they have a history of trauma and to tell the GP ahead of time about strategies they would like used during the screening process.”
General practices who would like a copy of the CheckOUT registration form can contact email@example.com
Some patients may be put off having bowel cancer screening by the ‘yuck’ factor. Clinicians should remind patients that bowel cancer is common, but can be successfully treated 90% of the time when caught early.24
Patients can also be advised that:
- only a very small amount of stool is required to complete the test and you can complete the test without having to handle your own stool
- the toilet liners are completely biodegradable and can be safely flushed down the toilet
- the samples are kept in a sealed tube and a zip-lock back, so you cannot see the sample in the tube and it’s completely safe to be kept in the fridge.