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

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.