CPCRN Cervical Cancer Workgroup Presentation Annual CPCRN Meeting, Chicago Tuesday, May 24th Lead: Karen Glanz, PhD, MPH Participating Sites: UPenn, UNC, UWash, CDC, NCI This presentation was supported by Cooperative Agreement Number U48 DP005053 from the Centers for Disease Control and Prevention. The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Project Objectives & Aims (2015-2017) Evaluate approaches and methods for increasing adherence to cervical cancer screening guidelines Systematic review of drivers and strategies for de-escalation of low-value cervical cancer screening practices Using a “positive deviance” approach, identify model organizational settings and learn from them (2) Examine the current state of cervical cancer screening practice and key determinants, with a focus on: Patient/provider perspectives on the new guidelines Methods for changing the healthy default for cervical cancer screening The role of insurance policies on reimbursements in guideline adherence The relationship between patients and providers in communicating/understanding new guidelines **To result in peer-reviewed publication(s) and grant proposals as applicable.

Work Completed/In-Progress Systematic review of the drivers and strategies for de-escalation of low-value cervical cancer screening practices Proposal Complete Timeline: May 2016 to April 2017

Literature Review Purpose: To understand the drivers of de-escalation and the strategies that can be used to increase adherence to cervical cancer screening guidelines. Background Existing literature has shown that adherence to 2012 Cervical Cancer Screening guidelines is low. Most providers do not adhere to the longer screening intervals. Research is needed to understand the drivers of de-escalation and the strategies that can be used to increase adherence to cervical cancer

Literature Review Research Questions What are the drivers of de-escalation of low-value cancer prevention services and practices? What methods and approaches have been effective in the de- escalation of low-value cancer prevention services and practices? What methods and approaches that have been effective in increasing cervical cancer screening could be applied to decreasing overuse of cervical cancer screenings?

Next Steps *Quality Check, Spot Checks Systematic Literature Steps Due by Workgroup Member Roles (Tentative) Overall coordination of steps & methods   Julia Alber, Alyssa Yackle & Karen Glanz Collection of articles’ citation and abstract May 2016 Julia Alber Initial screening of titles and abstracts (inclusion criteria 1-5) June 2016 Julia Alber, Cathy Melvin, Linda Ko, & Chyke Doubeni (student) (*KG) Full screening of titles and abstracts (remaining inclusion criteria/exclusion criteria) August 2016 Julia Alber, Cathy Melvin & Noel Brewer (student), Anatasha Crawford & Others (*KG) Full-text articles independently assessed by two researchers/students for eligibility October 2016 Linda Ko & Noel Brewer (student) & Others (*KG) Scanning of eligible articles’ reference lists Linda Ko & Noel Brewer (student), Anatasha Crawford & Others (*KG) Data extracted December 2016 Jennifer Leeman (student) & Others (*KG) Data synthesized February 2017 Jennifer Leeman (student), Jennifer Smith, & Others (*KG) Article written, revised, and prepared for submission April 2017 Karen Glanz, Cathy Melvin, Linda Ko, Noel Brewer, Julia Alber, Jennifer Smith, Chyke Doubeni, Anatasha Crawford *Quality Check, Spot Checks

Contribution/Impact: D&I Science (1) Evaluate approaches and methods for increasing adherence to cervical cancer screening guidelines Systematic review: Identifies the drivers and strategies for de-escalation of low- value screening practices Will inform the process of adopting the new cervical cancer guidelines (2) Examine the current state of cervical cancer screening practice and key determinants Will inform the process of spreading knowledge related to the new guidelines

Contribution/Impact: Cancer Prevention and Control Will provide better understanding the drivers of adoption of new guidelines Will identify strategies for improving overall adherence to cervical cancer guidelines Will determine the need for future research related to guideline adherence

Group Discussion Problems/challenges/decisions Input from group