A new report shares the voices of colposcopy staff across Ireland as they reflect on their experience of discussing cervical cancer audit results with patients in 2018. This study helped to inform the design of a review process for women diagnosed with cervical cancer after screening. The findings highlight the challenges and the learning involved in discussing review results with patients, offering valuable insights for future practice, support and system improvements.
Aim of the study
The study aimed to:
- listen to colposcopy staff and record their experiences of sharing the results of cervical cancer audits with patients and their families in 2018
- hear their suggestions on how to make audit and disclosure processes better for both patients and staff in the future.
What we did
- We invited staff from all 15 colposcopy clinics in Ireland who were working during the 2018 events to take part in the study.
- We used a mix of methods to gather their views including focus groups, one-to-one interviews and an online survey.
- We analysed the data looking for common themes in their responses to understand their experiences.
52 staff completed the survey, and 25 took part in focus groups. This included doctors, nurses, midwives, healthcare assistants and administrative staff.
Recommendations
Five key recommendations were identified which aim to improve communication, culture, crisis management, review processes and trauma-informed care.
- Communication: Develop and regularly update a communication strategy to clearly explain the benefits, limitations and complexities of screening to all stakeholders, including the media and politicians.
- Culture: Promote a ‘Just Culture’ that recognises adverse events as part of healthcare, builds trust and teamwork, and supports staff psychological safety, and access to training and emotional support after difficult events.
- Crisis management: Develop a crisis communications plan with input from key stakeholders that includes lessons learned from the events of 2018, ensures clear governance structures and processes, supports patients and staff, incorporates internal communications, and prepares for media or political challenges.
- Review process: Create a clear, standardised process for reviewing and discussing interval cancer audit results that includes a training plan for staff and personalised support for patients.
- Trauma-informed care: Develop a trauma-informed communication plan that supports staff in speaking openly and safely with patients after adverse events, includes clear policy guidance, draws on past experiences, and addresses fear of litigation and the impact of litigation on patients
Conclusion
This research gave colposcopy staff an opportunity to share their experience as part of a healing process. The aim was to learn from the past to improve communication and reduce harm to patients and staff in any future healthcare crises.
The research shows that rushing the communication of cervical cancer audit results in 2018 harmed the relationships between healthcare staff and their patients. It emphasises the need to carefully plan discussions about healthcare reviews to make sure patients are supported before, during and after the meetings. These meetings caused negative effects for everyone involved and staff felt that the meetings reduced the trust patients had in colposcopy staff as well as reducing their trust in the wider health service.
From research to action
We used the learnings from this study and from research we completed with patients affected by the cervical cancer audit in 2018 to improve our process of discussing cervical cancer audit results with women who are affected. We developed personal cervical screening reviews to offer a person-centred, caring and human approach to restoring trust in an open and transparent way.
We’ve published a progress report outlining the actions we’re taking to implement the recommendations of the research.
- This study was carried out by independent charity Quality Matters.
Related reading:
- Just culture in times of crisis: reflections from Ireland’s cervical screening programme – CervicalCheck
- Fitzpatrick P, Mooney T, Byrne H, Healy O, Russell N, O'Reilly S. Interval cancer audit and disclosure in cervical screening programmes: An international survey. J Med Screen. 2022 Jun;29(2):104-109. doi: 10.1177/09691413211062344. Epub 2021 Dec 13. PMID: 34894859.