Objectives
This dissertation had two overarching objectives:
1. To determine how stakeholders perceive women’s preferences for cervical
screening modalities.
2. To understand methods to measure women’s cervical screening preferences, to
inform the development and testing of a person-centered, evidence-informed approach to
preference-elicitation.
Methods
The overarching conceptual framework was the Ottawa Decision Support Framework.
The first objective was addressed by interview studies with (1) guideline developers and program
managers and (2) health professionals and women considering screening. This was
complemented by a systematic review of quantitative, qualitative and mixed-methods studies of
women’s cervical screening preferences, using the Grading of Recommendations, Assessment,
Development, and Evaluation approach to developing preference-based recommendations. This
approach was also used in a systematic review of methods to elicit women’s preferences,
addressing the second objective. These findings led to the development and field testing of a
preference-elicitation tool using International Patient Decision Aid Standards criteria, and the
development of a protocol for a population-based study of women’s preferences.
iv
Results
Objective 1
Experts disagree about whether there is enough evidence to include alternative modalities
in cervical screening programs. Women and health care professionals do not recognize that
women face a choice to participate in cervical screening. A narrative synthesis of relevant
literature presented challenges in aggregating preferences across diverse study objectives,
designs, and contexts.
Objective 2
Preference-elicitation approaches for cervical screening are heterogenous in design and
rigour. I therefore developed and field tested a tool to elicit women’s preferences, which
demonstrated that women found the tool helpful to identify their preferences. I then propose a study that uses multiple methods to apply the tool more broadly.
Conclusions
Synthesized preferences data might not be the optimal approach to incorporate preferences into cervical screening guidelines. A tool grounded in shared decision-making can help women identify their informed, values-based screening preferences.
| Identifer | oai:union.ndltd.org:uottawa.ca/oai:ruor.uottawa.ca:10393/38748 |
| Date | 25 January 2019 |
| Creators | Wood, Brianne |
| Contributors | Graham, Ian, Little, Julian |
| Publisher | Université d'Ottawa / University of Ottawa |
| Source Sets | Université d’Ottawa |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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