Patient- and Practice-Centered Assessment of Self-Collection

未能对女性进行宫颈癌筛查是有据可查的。目前的美国筛查计划 未能触及主要生活在低资源、医疗服务不足地区的一小部分人口，如 这是与贫困和/或种族差异有关的一系列疾病的一部分。这些人有典型的 与中等收入国家相似的癌症发病率，约占宫颈癌的60% 每年在美国发生的癌症病例有理由认为目前的宫颈癌 预防计划已经达到其极限，需要创新战略来克服这些 消除障碍，并进一步减轻服务不足人口的负担。HPV DNA检测提供了一种有希望的 扩大宫颈筛查覆盖面并同时满足患者和初级保健提供者的战略 护理过程中的挑战。HPV DNA检测对识别女性高度敏感(90%-95%) 当使用临床医生收集的样本时，宫颈癌前病变和癌症的敏感度要高出20%-50% 而不是常规的细胞学课程。因此，自我采集与HPV DNA检测相结合可能是 用于将访问范围扩大到当前基于Pap的计划未触及的女性。然而，在那里 在美国只进行了有限的、小型的自我收集研究，还需要更多的工作来确定 自我收集是不同患者群体可以接受的，也是整合的潜在障碍 将这种方法推广到初级保健环境中。这项混合方法研究旨在： 1.全面描述目前宫颈癌筛查和治疗护理的连续过程，并评估 一种有前途的新方法的翻译潜力--通过进行三个阶段的自我收集 序贯混合方法翻译研究(阶段1a)： 2.让美国印第安人和西班牙裔妇女参与共同开发适合文化的 自助收集方法(阶段lb)： 3.将实践评估和患者结果(目标1和2)结合起来进行干预，以评估 HPV自检与常规宫颈细胞学检测的可行性和可比性 在四个有目的地选择的初级保健临床环境中进行HPV联合检测：(第二阶段)

Failures to screen women for cervical cancer are well documented. The current U.S. screening program fails to reach small pockets of populations living mainly in low-resource, medically underserved regions as part of a complex of diseases linked to poverty and/or racial disparities. These populations have cen/ical cancer rates that are similar to middle-income countries and contribute approximately 60% of the cervical cancer cases that occur annually in the U.S. it is reasonable to suggest that the current cervical cancer prevention program has reached its limits and innovative strategies are needed to overcome these barriers and further reduce the burden in underserved populations. HPV DNA testing offers a promising strategy to enhance cervical screening coverage and address both patient and primary care provider challenges along the care process. HPV DNA testing is highly sensitive (90-95%) for identifying women with cervical precancer and cancer when using a clinician-collected specimen, and 20-50% more sensitive than routine cytology programs. Thus, self-collection combined with HPV DNA testing can potentially be used to extend access to women who are not reached by current Pap-based programs. However, there are only limited, small studies of self-collection in the U.S. and more work is needed to determine whether self-collection is acceptable to diverse patient populations as well as potential barriers toward integration of this approach into primary care settings. This mixed method study is designed to: 1. fully describe the current cervical cancer screening and treatment care continuum, and to assess the translational potential of a promising new approach¿self-collection¿by conducting a three-phase sequential mixed-method translational study (Phase la): 2. involve American Indian and Hispanic women in the co-development of a culturally-appropriate approach to self-collection (Phase lb): 3. integrate practice assessment and patient findings (Aims 1 and 2) in an intervention to assess the feasibility and comparability of self-collection methods for HPV testing and routine cervical cytology with HPV co-testing in four purposefully selected primary care clinical settings: (Phase 2)