The Population-Based Tailored Strategies of Invitation for Nationwide Cervical Cancer Screening

Background: Cervical cancer screening by Pap smear has markedly demonstrated the reduction on incidence and mortality, which is the key defense against cervical cancer in the world. But the screening efficacy highly depends on the attendance rate based on the screening before-after comparison using European countries. The high yields of cervical cancer incidence and mortality was highly dependent on the attendance rate of Pap smear. The nationwide pap smear screening for cervical cancer was lunched since 1995, however, the attendance rate of women aged 30-69 experienced screening with three-year only reached 58% based on the 2013 statistics report of national cervical cancer screening registry. This reveals we still have room to improve and to invest the Pap smear screening compared with other countries. It is challenging to enhance attendance rate based on the limit resource and manpower in local public health. Aims: Our project aims to (1) evaluate the efficacy and cost-effectiveness of different strategies of screening invitation which incorporated with hospital database based on RCT design, (2)identify the characteristics and factors between those who are tend to screening after invitation and those who are reluctant/reject to participate the Pap smear screening; therefore, we expect to construct the trailed approach for identification of tendency of attendance, which could provide the evidenced-based suggestion for specific invitation practice and investment in appropriate subjects to reduce cost and retrench manpower, (3)validate the trailed model for Pap smear screening using the eligible invitation list in next year. Materials and Methods: The eligible invitation list is conducted in Changhua community, which is systematically generated by Pap smear screening registry and links with local hospital database. The stratified randomized controlled trial will be carried out for evaluation of different invitation strategies for pas smear screening participation. The frequency in same hospital of health care visits per year could be ascertained from hospital. First, we stratify those women with more than 3-year non-attendees in to 3 stratification: no health care record, 1-3 times, and ≧4 times/per year in same hospital. After then, the randomized controlled trial was conducted to allocate into four groups: control, invitation letter, telephone reminding, and telephone with scheduling appointment. All evaluation was based on intention-to-treat analysis. Based on the RCT results, we used the hurdle model and zero-inflated model to identify the characteristics and other factors which affect the tendency of screening participation or not. The threshold regression model was used for time of intervention attrition and those regarding factors. The trailed algorithm for invitation will be generated based those models discussion. The validation for trailed approach would be carried out using the new candidate lists for Pap smear screening. Expected outcome: The efficacy of different invitation strategies for Pap smear screening will be evaluated, including invitation letter, telephone reminding, and telephone with scheduling appointment. The optimal investment subjects for Pap smear screening for cervical cancer prevention would be suggested based on those factors which identified from those statistical models we proposed.

Project ID:PC10701-0078
External Project ID:MOST105-2628-B182-003-MY3