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Longitudinal study of advanced practice nurses' implementation of screening intervals for cervical cancer screening

Cappiello, Joyce D. PhD, FNP, FAANP (Assistant Professor)1; Boardman, Maureen MSN, FNP, FAANP (Clinical Assistant Professor)2

Journal of the American Association of Nurse Practitioners: February 2018 - Volume 30 - Issue 2 - p 92–100
doi: 10.1097/JXX.0000000000000003
Quality Improvement Research

Background and purpose: The past two decades brought changes in cervical cancer screening guidelines. Frequent modifications and earlier lack of agreement about recommendations created confusion. The purpose of this study was to explore to what extent advanced practice nurses (APNs) adopted cervical cancer screening guidelines.

Methods: A longitudinal survey of 358 APNs conducted in three New England states regarding cervical cancer screening practices in 2008, 2012, and 2015.

Conclusions: Advanced practice nurses are incorporating guidelines at a high rate. Advanced practice nurses found it easier to incorporate guidelines to delay screening until the age of 21 years, to discontinue screening after total hysterectomy for benign reasons, and to discontinue screening at the age of 65 years. In 2012, 15% of APNs were screening women aged 21–29 years every 3 years; by 2015, this rate rose to 72%. By 2015, half of APNs were screening low-risk women aged 30–64 every 5 years. Because screening practices changed, APNs questioned the need to perform screening pelvic and breast examinations. Advanced practice nurses no longer perform screening pelvic examinations (93%) or breast examinations (75%) in adolescents.

Implications for practice: Some APNs indicated that office-based practice standards are barriers to adherence to guidelines. Advanced practice nurses need to be involved in practice committees to ensure that evidence guides practice decisions.

1Department of Nursing, University of New Hampshire, Durham, New Hampshire,

2Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire

Correspondence: Joyce D. Cappiello, PhD, FNP, FAANP, Department of Nursing, University of New Hampshire, Durham, NH 03824. Tel: 603-862-3207; E-mail:

Competing interests: The authors have no conflicts of interest.

Authors' contributions: Both authors equally developed the research project, developed the survey tool, and collected data. J.D. Cappiello conducted the analysis and wrote the initial draft of the article. M. Boardman reviewed the analysis and contributed to the second draft of the article.

Received July 10, 2017

Received in revised form September 29, 2017

Accepted October 02, 2017

© 2018 American Association of Nurse Practitioners
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