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Missed cancer screening opportunities among older women: a review.

PURPOSE
The authors present an analysis of the literature and findings from a qualitative research study as a framework for discussion of potential strategies to increase utilization of breast and cervical cancer screening among older women. The qualitative findings are one component of a comprehensive two-part study investigating why providers miss the opportunity to screen older women for cancer.


OVERVIEW
Qualitative analysis of in-depth interviews with experts in cancer control (academicians, clinicians, and cancer center administrators) and a survey of primary care providers revealed four emergent themes of patient, provider, office, and access barriers that contribute to underutilization of screening. Patient and provider barriers represent human factors or reasons why both groups may be reluctant to participate in screening. Office and access barriers exemplify systems factors that impede the screening process for both groups. Primary care providers may miss the opportunity to perform or recommend screening for underserved groups of older women because of their perceptions of these human and systems factors.


CLINICAL IMPLICATIONS
In light of the critical importance of primary care providers' recommendations, health professionals and community leaders should collaborate in developing multifaceted programs to help providers feel more comfortable about promoting screening to their patients. Such comprehensive, coordinated initiatives, which adapt successfully proven strategies to community needs and resources, may be essential to increase utilization of screening among underserved groups of older American women.