Connie McGilloway is an Advanced Nurse Practitioner and Forensic Clinical Examiner at the Sexual Assault Treatment Unit (SATU) in Donegal. Here, Connie talks about her role in developing a trauma-informed approach to cervical screening in the SATU, when she noticed many women using the service were not taking up their invitation for cervical screening.
“It’s so easy to be kind and compassionate, and vital to be aware of how trauma impacts people,” says Advanced Nurse Practitioner, Connie McGilloway. Connie works to promote “recovery, and health for women” at Donegal’s Sexual Assault Treatment Unit (SATU) - one of six in Ireland.
The SATU is for people aged 14 and over who have experienced sexual violence. It aims to provide responsive, holistic, patient-centred medical and forensic care, including on-site psychological support. Since 2017 it has also been providing follow-up clinics to women who are eligible for cervical screening and have no screening history, were delayed in accessing their free screening test, or have stopped attending.
Cervical screening is the most effective way to prevent cervical cancer by finding and treating pre-cancerous changes. And yet clinic staff identified through their health questionnaire that women who came to the unit were less likely to have had cervical screening.
Connie set up the screening clinic to “support women who have experienced sexual trauma to choose screening, by reducing the barriers that stop them from attending”.
Connie says she provides her patients with information about cervical screening and how to access it, “in a trauma-informed, non-judgmental, safe environment; one that promotes shared control and collaboration”.
Women who get screened are also given a streamlined pathway to follow-up care in colposcopy, if needed.
“Our work is supported by CervicalCheck, and by Letterkenny University Hospital Gynaecological service. All our SATU clinical staff are registered sample takers with CervicalCheck, and have completed the relevant accredited competencies,” she says.
“When we discuss screening, some women talk about feeling embarrassment, shame and guilt related to their experiences; or they are fearful they will have to talk about the abuse, with their GP or practice nurse. But by far the most common reason for not having a screening test was related to the nature of the test itself.
“For a woman who has suffered unwanted sexual contact, the trauma of that intimate examination can be overwhelming.
“We have a bed that allows women to lie in different positions. For some women, lying on their back can be re-traumatising. We consider everything, from how we touch the woman to the words we use, and we offer flexible appointment times. We can also offer more time with the woman. We’re gentle and go at the woman’s pace, getting her consent for every step, sharing control of what happens and when.”
The close collaboration with gynaecological and colposcopy services at Letterkenny University Hospital has been key. “We have close links with the colposcopy team in Letterkenny University Hospital. Many of the support staff in SATU also work in colposcopy so have strong awareness of the trauma associated with sexual violence,” Connie says.
When the screening results are returned, SATU clinical staff call each woman to talk them through and answer any questions. The SATU also supports groups in the community where trauma-informed care has been identified as a necessary priority for women.
Between 2018 and 2023, 72 women took part in screening at the Donegal SATU. Of these, 17 women (24%) were referred for follow-up to colposcopy services.
Connie says the importance of the service is reflected in the fact that a higher-than-average number of women have a repeat screening test and subsequent referral to colposcopy. “The reason for that could be lack of early detection, or the fact they haven’t had a test before,” Connie says.
“We give our patients access to an online platform to give us anonymous feedback about our service, so that we can improve it in line with women’s experiences. Women tell us that if they knew they were going to be looked after this way they would have gone for screening before now.
“...I haven’t gone for a test in 20 years, but knowing that someone would treat me the way they did would encourage me to go.” – woman attending Donegal Sexual Assault Treatment Unit, Ireland.
“......I knew the SATU team would look after me. I had to go to get a colposcopy which was so scary, the staff there work with SATU...they were so kind even though my legs were shaking... because they knew I was in SATU they were patient and didn’t put pressure on me. If I didn’t go to SATU I think I would be dead.” - woman attending Donegal Sexual Assault Treatment Unit, Ireland.
“The feedback we have received shows the real impact of high-quality, trauma informed healthcare,” Connie says.