Case Studies Learning objectives Demonstrate current knowledge of the National Cervical Screening Program NCSP and how this applies to clients Case study 1 Jenny Jenny 24 yo attends your clinic for a routine appointment and you notice she is overdue for cervical screening She recei ID: 1044409
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1. Cervical Screening in Practice Case Studies
2. Learning objectivesDemonstrate current knowledge of the National Cervical Screening Program (NCSP) and how this applies to clients
3. Case study 1 - JennyJenny 24 y.o. attends your clinic for a routine appointment, and you notice she is overdue for cervical screening. She received her full HPV vaccination in high school. She is hesitant to have a cervical test and not interested in taking part in cervical screening in the near future. What else would you like to know? Which points would you mention to help her understand the importance of regular cervical screening?
4. Cervical cancer in NSW
5. Case study 2You work in a general practice in an area with a large population of patients that are Aboriginal and Torres Strait Islander. You’re concerned about low rates of uptake of cervical screening in this group of women.What strategies could you implement to increase participation rates amongst Aboriginal and Torres Strait Islander women?
6. Case study 3 - JudithJudith is 42 and lives in a rural town. She has travelled more than two hours to your practice with a chest infection It has been eight or nine years since her last test. She explains that she is not comfortable screening with her local (male) GP Judith is adamant that she does not want cervical screening performed during her visit todayWhat options are open to Judith? What information should you give her with respect to self-collection?
7. Case study 4 - Aya Aya is a 26 y.o. student who had a Pap test 2 years ago (NAD). She returns for another Pap test in January 2018.You inform her about the changes to NCSP, and she expresses concern about moving form biannual to 5-yearly screening.How would you approach this situation? What would you need to explain to Aya? How would you address her concerns re: transition?
8. Case study 5 - Kim Kim presents for her routine cervical screening test but during your history taking discloses a 4-month history of intermittent post-coital bleeding. She has been together with her male partner for 1 year, and has used COCP for the last 6 months. What’s your management plan?
9. Case study 6 – Lucy, 36Lucy comes to see you in December 2017. She had a LLETZ procedure for CIN2 in mid-December 2014. Her last 2 PAP smears since then have been NAD, and she does not recall having HPV testing since her LLETZ procedure.What tests should Lucy have from now on?
10. Lucy does not appear to have had the Test of Cure as per previous post-treatment management recommendations, based on NHMRC guidelines 2005:Lucy needs to complete the Test of Cure: Dec 2017 – HPV DNA and LBCDec 2018 – HPV DNA and LBCIf both Negative, can go to 5-yearly cervical screeningCytologyColposcopyHPV4-6 monthsYY12 monthsYY24 monthsYYAnnually thereafter until Cytology and HPV both NAD on two consecutive occasions
11. Case study 7 – SusanSusan has mild intellectual disability and lives in a group home. She is sexually active. Susan receives a letter inviting her to have the new cervical screening test and presents to your practice with her carer Mary.* How would you approach the conversation with Susan about the Cervical Screening Test?How could you support Susan in making the decision to have a cervical screening test for herself?How might you improve information sharing with carers?
12. Barriers to ScreeningGeographicalPsychosocialEconomical Poor understanding Access to servicesCulturalPrevious negative experience/sexual assaultFear of resultEmbarrassmentFear of pain Cost Time constraintsCancer prevention Menstruation Asymptomatic Health priority
13. FPNSW resourcesTalkline: phone 1300 658 886Reproductive and Sexual Health: an Australian Clinical Practice Handbook 3rd editionFact Sheets: Cervical Screening and HPV vaccinationhttps://www.fpnsw.org.au/health-information/individuals/pap-test-and-cervical-screeningEverything you need to know about the changes to NSCPNational Cervical Screening Program (includes information in different languages)http://www.cancerscreening.gov.au/cervical