Physician Perspectives on the Transition to Primary Human Papillomavirus Testing for Cervical Cancer Screening

To identify barriers and facilitators to transitioning to primary human papillomavirus (HPV) testing from current cervical cancer screening practices among community OB/GYN physicians.

We conducted an exploratory qualitative study with in-depth interviews of 10 community-based OB/GYNs. Interviews were semistructured, utilizing an interview guide informed by the Consolidated Framework for Implementation Research, designed to explore current screening practices, perceptions of cytology versus primary HPV testing, recommended screening intervals, patient and physician acceptance of HPV-based testing, and anticipated changes in practice. Interviews were coded for recurring themes and organized into provider-, patient-, and system-level domains.

Identified barriers included interprovider variability in cervical cancer screening practices, fear of missing a cancer, concerns about loss of follow-up, patient preferences for more frequent screening, and talking about HPV with patients as a stressful/difficult process. Identified facilitators included awareness of possible upcoming changes in cervical cancer screening recommendations and previous adjustments in approach to cervical cancer screening.

Transitioning to this evidence-based cervical cancer screening modality will require targeted, multilevel strategies to address physician concerns and to promote the acceptability and adoption of primary HPV testing.