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. 2020 Apr;24(2):167-177.
doi: 10.1097/LGT.0000000000000524.

Incorporating Stakeholder Feedback in Guidelines Development for the Management of Abnormal Cervical Cancer Screening Tests

Rebecca B Perkins  1 , Lindsay N Fuzzell  2 , Paige Lake  2 , McKenzie McIntyre  2 , Ritu Nayar  3 , Mona Saraiya  4 , Jennifer Loukissas  5 , Tamika Felder  6 , Richard S Guido  7 , Susan T Vadaparampil  2
Affiliations

Incorporating Stakeholder Feedback in Guidelines Development for the Management of Abnormal Cervical Cancer Screening Tests

Rebecca B Perkins et al. J Low Genit Tract Dis. 2020 Apr.

Abstract

Objective: The 2019 ASCCP Risk-Based Management Consensus Guidelines present a paradigm shift from results- to risk-based management. Patient and provider factors can affect guideline adoption. We sought feedback from stakeholders to inform guideline development.

Materials and methods: To solicit provider feedback, we surveyed attendees at the 2019 ASCCP annual meeting regarding readiness to adopt proposed changes and used a web-based public comment period to gauge agreement/disagreement with preliminary guidelines. We elicited patient feedback via a brief survey on preferences around proposed recommendations for treatment without biopsy. Surveys and public comment included both closed-ended and free-text items. Quantitative results were analyzed using descriptive statistics; qualitative results were analyzed using content analysis. Results were incorporated into guideline development in real time.

Results: Surveys indicated that 98% of providers currently evaluate their patients' past results to determine management; 88% felt formally incorporating history into management would represent an improvement in care. Most providers supported expedited treatment without biopsy: 22% currently perform expedited treatment and 60% were willing to do so. Among patients, 41% preferred expedited treatment, 32% preferred biopsy before treatment, and the remainder were undecided. Responses from the public comment period included agreement/disagreement with preliminary guidelines, reasons for disagreement, and suggestions for improvement.

Conclusions: Stakeholder feedback was incorporated into the development of the 2019 ASCCP Risk-Based Management Consensus Guidelines. Proposed recommendations with less than two-thirds agreement in the public comment period were considered for revision. Findings underscore the importance of stakeholder feedback in developing guidelines that meet the needs of patients and providers.

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Conflict of interest statement

R.B.P. is a Co-Chair of the ASCCP Risk-Based Management Consensus Guidelines process. R.N., M.S., and J.L. are Co-Chairs for the Communication Working Group for the 2019 ASCCP Risk-Based Consensus Management Guidelines. T.F. is the founder of Cervivor, and served on the Treatment and Communications Working Groups for the 2019 ASCCP Risk-Based Consensus Management Guidelines. L.N.F., S.T.V., M.M., and P.L. have declared they have no conflicts of interest. The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the US Department of Health and Human Services, the National Cancer Institute, and the Centers for Disease Control and Prevention.

Figures

FIGURE 1
FIGURE 1
The ASCCP guideline revision and stakeholder feedback timeline. This figure illustrates the timeline of consensus guideline development process highlighting time points at which stakeholder feedback was solicited and presented/incorporated into guideline development and revision.
FIGURE 2
FIGURE 2
Patient survey precancer treatment preference by age group (n = 104). This figure illustrates patients' desire for expedited treatment based on age. Women 50 years and older were more likely to prefer expedited treatment than younger women (p = .015).
FIGURE 3
FIGURE 3
Agreement with the ASCCP risk-based management consensus guidelines during public comment period (n = 242). This figure illustrates percent agreement with preliminary guidelines statements as expressed during the open public comment period. The gray line represents two-thirds agreement, which was the threshold used to consider revision of preliminary guidelines before presentation at the final voting conference.
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