Pan-Canadian survey on the impact of the COVID-19 pandemic on cervical cancer screening and management: cross-sectional survey of healthcare professionals
- Division of Cancer Epidemiology, McGill University, Canada
Figures
Figure 1
Description of survey elements and administration, and respondent flowchart.
Figure 2
Cancellations and postponements of screening appointments by province, profession, and place of practice (n=510).
Number of cancellations are shown by (A) province, (B) profession, and (C) place of practice. Number of postponements are shown by (D) province, (E) profession, and (F) place of practice. Answers include responses for questions 6 (cancellations) and 8 (postponements) by questions 2 (province), 4 (profession), and 5 (place of practice). Panels A and D: Territories include Northwest Territories, Nunavut, and Yukon. Other provinces include Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Prince Edward Island, Quebec, and Saskatchewan (and one respondent who preferred not to say). Panels B and E: Primary includes general practitioners/family physicians, nurse practitioners/registered nurses, physician assistants, and a manager of a community health center; secondary (clinical) includes colposcopists and colposcopy registered nurses/registered practical nurses; secondary (cytological) includes cytopathologists/technologists and pathologists; tertiary includes gynecologists/obstetrician-gynecologists, gynecology oncologists, and gynecology nurses. Panels B, C, E, and F: Frequency count exceeded total number of respondents as some reported multiple professions and places of practice. DK: Don’t know; NA: Not applicable to my practice.
Figure 3
Cancelled (n=325) and postponed (n=382) screening appointments by province that were cancelled or postponed by physician/providers’ institution, by patient, or converted to telemedicine.
Number cancelled by (A) physician or providers’ institution, (B) patient, and (C) converted to telemedicine. Number postponed by (D) physician or providers’ institution, (E) patient, and (F) converted to telemedicine. Answers include responses for questions 7 (cancellations) and 9 (postponements) by question 2 (province). Respondents were asked to ensure that their answers did not exceed 100% for each question. (i.e., for each respondent, A+B+C ≈ 100% and D+E+F ≈ 100%). The x axis represents frequency of responses by province. Territories include Northwest Territories, Nunavut, and Yukon. Other provinces include Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Prince Edward Island, Quebec, and Saskatchewan (and one respondent who preferred not to say). The y axis represents cancelled or postponed screening appointments using a predefined interval scale. DK: Don’t know.
Figure 4
Cancelled (n=325) and postponed (n=382) screening appointments by profession that were cancelled or postponed by physician/providers’ institution, by patient, or converted to telemedicine.
Number cancelled by (A) physician or providers’ institution, (B) patient, and (C) converted to telemedicine. Number postponed by (D) physician or providers’ institution, (E) patient, and (F) converted to telemedicine. Answers include responses for questions 7 (cancellations) and 9 (postponements) by question 4 (profession). Respondents were asked to ensure that their answers did not exceed 100% for each question. (i.e., for each respondent, A+B+C ≈ 100% and D+E+F ≈ 100%). The x axis represents frequency of responses by profession. Primary includes general practitioners/family physicians, nurse practitioners/registered nurses, physician assistants, and a manager of a community hospital; secondary (clinical) includes colposcopists and colposcopy registered nurses/registered practical nurses; secondary (cytological) includes cytopathologists/technologists and pathologists; tertiary includes gynecologists/obstetrician-gynecologists, gynecology oncologists, and gynecology nurses. Frequency count exceeded total number of respondents as some reported multiple professions. The y axis represents cancelled or postponed screening appointments using a predefined interval scale. DK: Don’t know.
Figure 5
Cancelled (n=325) and postponed (n=382) screening appointments by place of practice that were cancelled or postponed by physician/providers’ institution, by patient, or converted to telemedicine.
Number cancelled by (A) physician or providers’ institution, (B) patient, and (C) converted to telemedicine. Number postponed by (D) physician or providers’ institution, (E) patient, and (F) converted to telemedicine. Answers include responses for questions 7 (cancellations) and 9 (postponements) by question 5 (place of practice). Respondents were asked to ensure that their answers did not exceed 100% for each question. (i.e., for each respondent, A+B+C ≈ 100% and D+E+F ≈ 100%). The x axis represents frequency of responses by place of practice. Frequency count exceeded total number of respondents as some reported multiple places of practice. The y axis represents cancelled or postponed screening appointments using a predefined interval scale. DK: Don’t know.
Figure 6
Allowance of in-person consultations during the peak period of the pandemic by province, profession, and place of practice (n=510).
Number of in person consultations is shown by (A) province, (B) profession, and (C) place of practice. Answers include responses for question 11 by questions 2 (province), 4 (profession), and 5 (place of practice). Panel A: Territories include Northwest Territories, Nunavut, and Yukon. Other provinces include Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Prince Edward Island, Quebec, and Saskatchewan (and one respondent who preferred not to say). Panel B: Primary includes general practitioners/family physicians, nurse practitioners/registered nurses, physician assistants, and a manager of a community health center; secondary (clinical) includes colposcopists and colposcopy registered nurses/registered practical nurses; Secondary (cytological) includes cytopathologists/technologists and pathologists; Tertiary includes gynecologists/obstetrician-gynecologists, gynecology oncologists, and gynecology nurses. Panels B and C: Frequency count exceeded total number of respondents as some reported multiple professions and places of practice. DK: Don’t know; NA: Not applicable to my practice.
Figure 7
Deferral period for postponed screening appointments by province, profession, and place of practice (n=467).
Deferral period for postponed Pap test appointments is shown by (A) province, (B) profession, and (C) place of practice. Deferral period for postponed human papillomavirus (HPV) test appointments is shown by (D) province, (E) profession, and (F) place of practice. Deferral period for postponed HPV/Pap co-test appointments is shown (G) province, (H) profession, and (I) place of practice. Answers include responses for question 19 by questions 2 (province), 4 (profession), and 5 (place of practice). Panels A, D, and G: Territories include Northwest Territories, Nunavut, and Yukon. Other provinces include Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Prince Edward Island, Quebec, and Saskatchewan (and one respondent who preferred not to say). Panels B, E, and H: Primary includes general practitioners/family physicians, nurse practitioners/registered nurses, physician assistants, and a manager of a community health center; secondary (clinical) includes colposcopists and colposcopy registered nurses/registered practical nurses; secondary (cytological) includes cytopathologists/technologists and pathologists; tertiary includes gynecologists/obstetrician-gynecologists, gynecology oncologists, and gynecology nurses. Panels B, C, E, F, H, and I: Frequency count exceeded total number of respondents as some reported multiple professions and places of practice. DK: Don’t know; NA: Not applicable to my practice.
Figure 8 with 3 supplements
Cancellations and postponements of colposcopy appointments by province, profession, and place of practice (n=452).
Number of cancellations are shown by (A) province, (B) profession, and (C) place of practice. Number of postponements are shown by (D) province, (E) profession, and (F) place of practice. Answers include responses for questions 25 (cancellations) and 27 (postponements) by questions 2 (province), 4 (profession), and 5 (place of practice). Panels A and D: Territories include Northwest Territories, Nunavut, and Yukon. Other provinces include Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Prince Edward Island, Quebec, and Saskatchewan (and one respondent who preferred not to say). Panels B and E: Primary includes general practitioners/family physicians, nurse practitioners/registered nurses, physician assistants, and a manager of a community health center; secondary (clinical) includes colposcopists and colposcopy registered nurses/registered practical nurses; secondary (cytological) includes cytopathologists/technologists and pathologists; tertiary includes gynecologists/obstetrician-gynecologists, gynecology oncologists, and gynecology nurses. Panels B, C, E, and F: Frequency count exceeded total number of respondents as some reported multiple professions and places of practice. DK: Don’t know; NA: Not applicable to my practice.
Figure 8—figure supplement 1
Cancelled (n=114) and postponed (n=167) colposcopy appointments by province that were cancelled or postponed by physician/providers’ institution or by patient.
Number cancelled by (A) physician or providers’ institution and (B) patient. Number postponed by (C) physician or providers’ institution and (D) patient. Answers include responses for questions 26 (cancellations) and 28 (postponements) by question 2 (province). Respondents were asked to ensure that their answers did not exceed 100% for each question. (i.e., for each respondent, A+B ≈ 100% and C+D ≈ 100%). The x axis represents frequency of responses by province. Territories include Northwest Territories, Nunavut, and Yukon. Other provinces include Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Prince Edward Island, Quebec, and Saskatchewan (and one respondent who preferred not to say). The y axis represents cancelled or postponed colposcopy appointments using a predefined interval scale. DK: Don’t know.
Figure 8—figure supplement 2
Cancelled (n=114) and postponed (n=167) colposcopy appointments by profession that were cancelled or postponed by physician/providers’ institution or by patient.
Number cancelled by (A) physician or providers’ institution and (B) patient. Number postponed by (C) physician or providers’ institution and (D) patient. Answers include responses for questions 26 (cancellations) and 28 (postponements) by question 4 (profession). Respondents were asked to ensure that their answers did not exceed 100% for each question. (i.e., for each respondent, A+B ≈ 100% and C+D ≈ 100%). The x axis represents frequency of responses by profession. Primary includes general practitioners/family physicians, nurse practitioners/registered nurses, and physician assistants; secondary (clinical) includes colposcopists and colposcopy registered nurses/registered practical nurses; secondary (cytological) includes cytopathologists/technologists and pathologists; tertiary includes gynecologists/obstetrician-gynecologists, gynecology oncologists, and gynecology nurses. Frequency count exceeded total number of respondents as some reported multiple professions. The y axis represents cancelled or postponed colposcopy appointments using a predefined interval scale. DK: Don’t know.
Figure 8—figure supplement 3
Cancelled (n=114) and postponed (n=167) colposcopy appointments by place of practice that were cancelled or postponed by physician/providers’ institution or by patient.
Number cancelled by (A) physician or providers’ institution and (B) patient. Number postponed by (C) physician or providers’ institution and (D) patient. Answers include responses for questions 26 (cancellations) and 28 (postponements) by question 5 (place of practice). Respondents were asked to ensure that their answers did not exceed 100% for each question. (i.e., for each respondent, A+B ≈ 100% and C+D ≈ 100%). The x axis represents frequency of responses by place of practice. Frequency count exceeded total number of respondents as some reported multiple places of practice. The y axis represents cancelled or postponed colposcopy appointments using a predefined interval scale. DK: Don’t know.
Figure 9 with 3 supplements
Cancellations and postponements of follow-up appointments by province, profession, and place of practice (n=445).
Number of cancellations are shown by (A) province, (B) profession, and (C) place of practice. Number of postponements are shown by (D) province, (E) profession, and (F) place of practice. Answers include responses for questions 31 (cancellations) and 33 (postponements) by questions 2 (province), 4 (profession), and 5 (place of practice). Panels A and D: Territories include Northwest Territories, Nunavut, and Yukon. Other provinces include Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Prince Edward Island, Quebec, and Saskatchewan (and one respondent who preferred not to say). Panels B and E: Primary includes general practitioners/family physicians, nurse practitioners/registered nurses, physician assistants, and a manager of a community health center; secondary (clinical) includes colposcopists and colposcopy registered nurses/registered practical nurses; secondary (cytological) includes cytopathologists/technologists and pathologists; tertiary includes gynecologists/obstetrician-gynecologists, gynecology oncologists, and gynecology nurses. Panels B, C, E, and F: Frequency count exceeded total number of respondents as some reported multiple professions and places of practice. DK: Don’t know; NA: Not applicable to my practice.
Figure 9—figure supplement 1
Cancelled (n=148) and postponements (n=238) of follow-up appointments by province that were cancelled or postponed by physician/providers’ institution, by patient, or converted to telemedicine.
Number cancelled by (A) physician or providers’ institution, (B) patient, and (C) converted to telemedicine. Number postponed by (D) physician or providers’ institution, (E) patient, and (F) converted to telemedicine. Answers include responses for questions 32 (cancellations) and 34 (postponements) by question 2 (province). Respondents were asked to ensure that their answers did not exceed 100% for each question (i.e., for each respondent, A+B+C ≈ 100% and D+E+F ≈ 100%). The x axis represents frequency of responses by province. Territories include Northwest Territories, Nunavut, and Yukon. Other provinces include Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Prince Edward Island, Quebec, and Saskatchewan (and one respondent who preferred not to say). The y axis represents cancelled or postponed follow-up appointments using a predefined interval scale. DK: Don’t know.
Figure 9—figure supplement 2
Cancelled (n=148) and postponed (n=238) follow-up appointments by profession that were cancelled or postponed by physician/providers’ institution, by patient, or converted to telemedicine.
Number cancelled by (A) physician or providers’ institution, (B) patient, and (C) converted to telemedicine. Number postponed by (D) physician or providers’ institution, (E) patient, and (F) converted to telemedicine. Answers include responses for questions 32 (cancellations) and 34 (postponements) by question 4 (profession). Respondents were asked to ensure that their answers did not exceed 100% for each question. (i.e., for each respondent, A+B+C ≈ 100% and D+E+F ≈ 100%). The x axis represents frequency of responses by profession. Primary includes general practitioners/family physicians, nurse practitioners/registered nurses, and physician assistants; secondary (clinical) includes colposcopists and colposcopy registered nurses/registered practical nurses; secondary (cytological) includes cytopathologists/technologists and pathologists; tertiary includes gynecologists/obstetrician-gynecologists, gynecology oncologists, and gynecology nurses. Frequency count exceeded total number of respondents as some reported multiple professions. The y axis represents cancelled or postponed follow-up appointments using a predefined interval scale. DK: Don’t know.
Figure 9—figure supplement 3
Cancelled (n=148) and postponed (n=238) follow-up appointments by place of practice that were cancelled or postponed by physician/providers’ institution, by patient, or converted to telemedicine.
Number cancelled by (A) physician or providers’ institution, (B) patient, and (C) converted to telemedicine. Number postponed by (C) physician or providers’ institution, (D) patient, and (E) converted to telemedicine. Answers include responses for questions 32 (cancellations) and 34 (postponements) by question 5 (place of practice). Respondents were asked to ensure that their answers did not exceed 100% for each question. (i.e., for each respondent, A+B+C ≈ 100% and D+E+F ≈ 100%). The x axis represents frequency of responses by place of practice. Frequency count exceeded total number of respondents as some reported multiple places of practice. The y axis represents cancelled or postponed follow-up appointments using a predefined interval scale. DK: Don’t know.
Figure 10
Cancellations or postponements of treatment procedures by province (n=431).
Number of cancellations or postponements of (A) cold knife conization, (B) other excisional (e.g., LEEP), (C) ablative procedures, (D) hysterectomy, (E) chemotherapy, and (F) radiation are shown by province. Answers include the responses for question 39 by question 2. Territories include Northwest Territories, Nunavut, and Yukon. Other provinces include Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Prince Edward Island, Quebec, and Saskatchewan (and one respondent who preferred not to say). DK: Don’t know; NA: Not applicable to my practice.
Figure 11
Cancellations or postponements of treatment procedures by profession (n=431).
Number of cancellations or postponements of (A) cold knife conization, (B) other excisional (e.g., LEEP), (C) ablative procedures, (D) hysterectomy, (E) chemotherapy, and (F) radiation are shown by profession. Answers include the responses for question 39 by question 4. Primary includes general practitioners/family physicians, nurse practitioners/registered nurses, physician assistants, and a manager of a community health center; secondary (clinical) includes colposcopists and colposcopy registered nurses/registered practical nurses; secondary (cytological) includes cytopathologists/technologists and pathologists; tertiary includes gynecologists/obstetrician-gynecologists, gynecology oncologists, and gynecology nurses. Frequency count exceeded total number of respondents as some reported multiple professions. DK: Don’t know; NA: Not applicable to my practice.
Figure 12
Cancellations or postponements of treatment procedures by place of practice (n=431).
Number of cancellations or postponements of (A) cold knife conization, (B) other excisional (e.g., LEEP), (C) ablative procedures, (D) hysterectomy, (E) chemotherapy, and (F) radiation are shown by place of practice. Answers include the responses for question 39 by question 5. Frequency count exceeded total number of respondents as some reported multiple places of practice. DK: Don’t know; NA: Not applicable to my practice.
Figure 13
Percentage of patients attending routine screening compared to pre-coronavirus disease 2019 (pre-COVID-19) by province, profession, and place of practice (n=421).
Proportions are shown by (A) province, (B) profession, and (C) place of practice. Answers include responses for question 57 by questions 2 (province), 4 (profession), and 5 (place of practice). Panel A: Territories include Northwest Territories, Nunavut, and Yukon. Other provinces include Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Prince Edward Island, Quebec, and Saskatchewan (and one respondent who preferred not to say). Panel B: Primary includes general practitioners/family physicians, nurse practitioners/registered nurses, physician assistants, and a manager of a community health center; secondary (clinical) includes colposcopists and colposcopy registered nurses/registered practical nurses; secondary (cytological) includes cytopathologists/technologists and pathologists; tertiary includes gynecologists/obstetrician-gynecologists, gynecology oncologists, and gynecology nurses. Panels B and C: Frequency count exceeded total number of respondents as some reported multiple places of practice. DK: Don’t know; NA: Not applicable to my practice.
Figure 14
Responses to open-ended Q22 by province, profession, and place of practice (n=206).
Opinions and perspectives are shown by (A) province, (B) profession, and (C) place of practice. Answers include responses for question 22 (coronavirus disease 2019 [COVID-19] to encourage/facilitate/accelerate implementation of human papillomavirus [HPV] self-sampling) by questions 2 (province), 4 (profession), and 5 (place of practice). Panel A: Territories include Northwest Territories, Nunavut, and Yukon. Other provinces include Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Prince Edward Island, Quebec, and Saskatchewan (and one respondent who preferred not to say). Panel B: Primary includes general practitioners/family physicians, nurse practitioners/registered nurses, physician assistants, and a manager of a community center; secondary (clinical) includes colposcopists and colposcopy registered nurses/registered practical nurses; secondary (cytological) includes cytopathologists/technologists and pathologists; tertiary includes gynecologists/obstetrician-gynecologists, gynecology oncologists, and gynecology nurses. Panels B and C: Frequency count exceeded total number of respondents as some reported multiple professions and places of practice.
Figure 15
Responses to open-ended Q23 by province, profession, and place of practice (n=197).
Opinions and perspectives are shown by (A) province, (B) profession, and (C) place of practice. Answers include responses for question 23 (in favor of implementing human papillomavirus [HPV] self-sampling as alternative screening method) by questions 2 (province), 4 (profession), and 5 (place of practice). Panel A: Territories include Northwest Territories, Nunavut, and Yukon. Other provinces include Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Prince Edward Island, Quebec, and Saskatchewan (and one respondent who preferred not to say). Panel B: Primary includes general practitioners/family physicians, nurse practitioners/registered nurses, physician assistants, and a manager of a community health center; secondary (clinical) includes colposcopists and colposcopy registered nurses/registered practical nurses; secondary (cytological) includes cytopathologists/technologists and pathologists; tertiary includes gynecologists/obstetrician-gynecologists, gynecology oncologists, and gynecology nurses. Panels B and C: Frequency count exceeded total number of respondents as some reported multiple professions and places of practice.
Tables
Table 1
Characteristics of survey respondents (n=510).
| Variable | Categories | n (%) |
|---|---|---|
| Sex | Female | 284 (55.7) |
| Male | 124 (24.3) | |
| Not reported | 102 (20.0) | |
| Age | 20–29 | 26 (5.1) |
| 30–39 | 122 (23.9) | |
| 40–49 | 98 (19.2) | |
| 50–59 | 70 (13.7) | |
| 60–69 | 42 (8.2) | |
| 70+ | 7 (1.4) | |
| Not reported | 145 (28.4) | |
| Province/territory | Alberta | 65 (12.8) |
| British Columbia | 107 (21.0) | |
| Manitoba | 18 (3.5) | |
| New Brunswick | 19 (3.7) | |
| Newfoundland and Labrador | 7 (1.4) | |
| Northwest Territories | 9 (1.8) | |
| Nova Scotia | 21 (4.1) | |
| Nunavut | 4 (0.8) | |
| Ontario | 209 (41.0) | |
| Prince Edward Island | 2 (0.4) | |
| Quebec | 21 (5.1) | |
| Saskatchewan | 26 (5.1) | |
| Yukon | 1 (0.2) | |
| Not reported | 1 (0.2) | |
| Profession* | Colposcopist | 52 (10.2) |
| Colposcopy registered nurse/registered practical nurse | 16 (3.1) | |
| Cytopathologist/technologist | 44 (8.6) | |
| General practitioner/family physician | 223 (43.7) | |
| Gynecologist/obstetrician-gynecologist | 110 (21.6) | |
| Gynecology oncologist | 32 (6.3) | |
| Gynecology nurse | 21 (4.1) | |
| Nurse practitioner/registered nurse | 72 (14.1) | |
| Pathologist | 17 (3.3) | |
| Physician assistant | 7 (1.4) | |
| Other (manager in a community health center) | 1 (0.2) | |
| Place of practice* | University-affiliated hospital | 124 (24.3) |
| Community hospital | 142 (27.8) | |
| Public clinic | 129 (25.3) | |
| Private clinic | 168 (32.9) | |
| Community health center | 37 (7.3) | |
| Other (homeless shelter [nurse]; private lab [cytotechnologist]) | 2 (0.4) |
-
*
Frequency count exceeded number of respondents (510) as some selected more than one answer.
Table 2
Cancellations and postponements of cervical cancer screening appointments.
| Question number and content (number of responses) | Categories | n (%) | |
|---|---|---|---|
| Q6 Cancellations of screening appointments (n=510) | Yes | 325 (63.7) | |
| No | 114 (22.4) | ||
| Don’t know | 39 (7.7) | ||
| Not applicable to my practice | 32 (6.3) | ||
| Q7 Percentage of cancelled screening appointments (n=325) | Cancelled by physician or provider’s institution | 0% | 37 (11.4) |
| 1–24% | 107 (32.9) | ||
| 25–49% | 74 (22.8) | ||
| 50–74% | 53 (16.3) | ||
| ≥75% | 35 (10.8) | ||
| Don’t know | 19 (5.8) | ||
| Cancelled by patient | 0% | 8 (2.5) | |
| 1–24% | 124 (38.2) | ||
| 25–49% | 83 (25.5) | ||
| 50–74% | 44 (13.5) | ||
| ≥75% | 42 (12.9) | ||
| Don’t know | 24 (7.4) | ||
| Converted to telemedicine | 0% | 77 (23.7) | |
| 1–24% | 88 (27.1) | ||
| 25–49% | 44 (13.5) | ||
| 50–74% | 56 (17.2) | ||
| ≥75% | 36 (11.1) | ||
| Don’t know | 24 (7.4) | ||
| Q8 Postponements of screening practices (n=510) | Yes | 382 (74.9) | |
| No | 73 (14.3) | ||
| Don’t know | 24 (4.7) | ||
| Not applicable to my practice | 31 (6.1) | ||
| Q9 Percentage of postponed screening appointments (n=382) | Postponed by physician or provider’s institution | 0% | 40 (10.5) |
| 1–24% | 110 (28.8) | ||
| 25–49% | 87 (22.8) | ||
| 50–74% | 66 (17.3) | ||
| ≥75% | 54 (14.1) | ||
| Don’t know | 25 (6.6) | ||
| Postponed by patient | 0% | 12 (3.1) | |
| 1–24% | 153 (40.1) | ||
| 25–49% | 108 (28.3) | ||
| 50–74% | 46 (12.0) | ||
| ≥75% | 33 (8.7) | ||
| Don’t know | 30 (7.9) | ||
| Converted to telemedicine | 0% | 103 (27.0) | |
| 1–24% | 104 (27.2) | ||
| 25–49% | 60 (15.7) | ||
| 50–74% | 53 (13.9) | ||
| ≥75% | 29 (7.6) | ||
| Don’t know | 33 (8.6) | ||
| Q10 Length of deferral period for postponed screening appointments (n=382) | 1 week to <2 weeks | 15 (3.9) | |
| 2 weeks to <4 weeks | 47 (12.3) | ||
| 1 month to <2 months | 66 (17.3) | ||
| 2 months to <4 months | 118 (30.9) | ||
| 4 months to <6 months | 78 (20.4) | ||
| >6 months | 36 (9.4) | ||
| Don’t know | 22 (5.7) | ||
Table 3
Adoption of telemedicine (n=429*).
| Question number and content | Categories | n (%) |
|---|---|---|
| Q43 Adoption of telemedicine to communicate with patients | Yes, with all patients | 179 (41.7) |
| Yes, with low-risk patients only | 205 (47.8) | |
| No | 23 (5.4) | |
| Don’t know | 9 (2.1) | |
| Not applicable to my practice | 13 (3.0) | |
| Q44 Percentage of patients called (audio/video) for distance consultation | 0% | 17 (4.0) |
| 1–24% | 83 (19.4) | |
| 25–49% | 115 (26.8) | |
| 50–74% | 105 (24.5) | |
| ≥75% | 83 (19.4) | |
| Don’t know | 5 (1.2) | |
| Not applicable to my practice | 21 (4.9) | |
| Q45 Percentage of patients called (audio/video) for follow-up to a cervical cancer screening procedure | 0% | 46 (10.7) |
| 1–24% | 103 (24.0) | |
| 25–49% | 85 (19.8) | |
| 50–74% | 83 (19.3) | |
| ≥75% | 68 (15.9) | |
| Don’t know | 18 (4.2) | |
| Not applicable to my practice | 26 (6.1) | |
| Q46 Virtual consultations compensated by jurisdictional public health insurance system | Yes | 312 (72.7) |
| No | 43 (10.0) | |
| Don’t know | 44 (10.3) | |
| Not applicable to my practice | 30 (7.0) | |
| Q47 Appropriate interactions to convert to telemedicine† | Health and medical history reporting | 283 (66.0) |
| Test results reporting | 352 (82.1) | |
| Consent forms completion prior to in-person procedures | 222 (51.7) | |
| Post-procedure follow-up | 219 (42.9) | |
| In-person appointment planning/scheduling | 169 (33.1) | |
| Other | 5 (1.2) |
-
*
Eighty-one respondents did not answer; the total number of complete responses was used as the denominator.
-
†
Frequency count exceeded number of respondents (429) as some selected more than one answer.
Table 4
Over-screening and under-screening in the pre-coronavirus disease 2019 (pre-COVID-19) era (n=427*).
| Question number and content† | Categories | n (%) |
|---|---|---|
| Q48 Prevalence of over-screening/over-diagnosis/over-treatment of cervical lesions pre-COVID-19 | Yes, over-screening | 68 (15.9) |
| Yes, over-diagnosis | 86 (20.1) | |
| Yes, over-treatment | 36 (8.5) | |
| No | 224 (52.5) | |
| Don’t know | 37 (8.7) | |
| Q49 Current delays/cancellations of screening/management procedures have had a positive impact by reducing unnecessary screening/diagnosis/treatment | Yes, over-screening | 65 (15.2) |
| Yes, over-diagnosis | 88 (20.6) | |
| Yes, over-treatment | 45 (10.5) | |
| No | 188 (44.0) | |
| Don’t know | 66 (15.5) | |
| Q50 Prevalence of under-screening/under-diagnosis/under-treatment of cervical lesions pre-COVID-19 | Yes, under-screening | 161 (37.7) |
| Yes, under-diagnosis | 127 (29.7) | |
| Yes, under-treatment | 62 (14.5) | |
| No | 109 (25.5) | |
| Don’t know | 54 (12.6) | |
| Q51 Current delays/cancellations of screening/management procedures have had a negative impact by reducing necessary screening/diagnosis/treatment | Yes, under-screening | 204 (47.8) |
| Yes, under-diagnosis | 207 (48.4) | |
| Yes, under-treatment | 129 (25.3) | |
| No | 48 (9.4) | |
| Don’t know | 50 (11.7) |
-
*
Eighty-three respondents did not answer; the total number of complete responses was used as the denominator.
-
†
Frequency count exceeded number of respondents (427) as some selected more than one answer.
Table 5
Resumption of in-person practice (n=421*).
| Question number and content | Categories | n (%) |
|---|---|---|
| Q53 Practice/institution caught up with cancellations/postponements | Yes | 190 (45.1) |
| No | 147 (34.9) | |
| Don’t know | 58 (13.8) | |
| Not applicable to my practice | 26 (6.2) | |
| Q54 Measures implemented to catch up with cancellations/postponements† | Allow longer workdays and/or working on weekends | 91 (21.6) |
| Increase availability of OR for treatment procedures | 91 (21.6) | |
| Convert OR procedures, if possible, to take place in clinics | 74 (17.6) | |
| Increase availability to labs for processing test samples | 48 (11.4) | |
| Other | 51 (11.9) | |
| Don’t know | 41 (9.7) | |
| Not applicable to my practice | 92 (21.9) | |
| Q55 Percentage of cancellations/postponements currently caught up with | 0% | 5 (1.2) |
| 1–24% | 60 (14.3) | |
| 25–49% | 98 (23.3) | |
| 50–74% | 72 (17.1) | |
| ≥75% | 88 (20.9) | |
| Don’t know | 55 (13.1) | |
| Not applicable to my practice | 43 (10.2) | |
| Q56 Patients attending routine screening at equivalent capacity to pre-COVID-19 era | Yes | 132 (31.4) |
| No | 216 (51.3) | |
| Don’t know | 52 (12.4) | |
| Not applicable to my practice | 21 (5.0) | |
| Q57 Percentage of patients attending routine screening compared to pre-COVID-19 | 0% | 3 (0.7) |
| 1–24% | 75 (17.8) | |
| 25–49% | 123 (29.2) | |
| 50–74% | 89 (21.1) | |
| ≥75% | 76 (18.1) | |
| Don’t know | 35 (8.3) | |
| Not applicable to my practice | 20 (4.8) | |
| Q58 Increase in frequency of patients with worsening of symptoms during screening | Yes | 136 (32.3) |
| No | 216 (51.3) | |
| Don’t know | 47 (11.2) | |
| Not applicable to my practice | 22 (5.2) | |
| Q59 Percentage of patients diagnosed with more advanced cytological abnormalities/lesions, in comparison to pre-COVID-19 | 0% | 98 (23.3) |
| 1–24% | 94 (22.3) | |
| 25–49% | 70 (16.6) | |
| 50–74% | 42 (10.0) | |
| ≥75% | 6 (1.4) | |
| Don’t know | 95 (22.6) | |
| Not applicable to my practice | 16 (3.8) | |
| Q60 Screening patients (with COVID-19) for cervical cancer | Yes | 113 (26.8) |
| No | 222 (52.7) | |
| Don’t know | 58 (13.8) | |
| Not applicable to my practice | 28 (6.7) |
-
*
Eighty-nine respondents did not answer; the total number of complete responses was used as the denominator.
-
†
Frequency count exceeded number of respondents (421) as some selected more than one answer.
Table 6
Content analysis of open-ended questions.
| Question number and content(number of responses) | Opinions and perspectives | n (%) |
|---|---|---|
| Q22 COVID-19 to encourage/facilitate/accelerate implementation of HPV self-sampling in cervical cancer screening programs, briefly justify your answer (n=206) | Favorable approach | 85 (41.3) |
| Not favorable | 18 (8.7) | |
| Challenges faced* | 47 (22.8) | |
| Not familiar with HPV self-sampling† | 30 (14.6) | |
| ‘No comment’ written | 6 (2.9) | |
| Don’t know | 12 (5.8) | |
| Unclear answer | 8 (3.9) | |
| Q23 In favor of implementing HPV self-sampling as alternative screening method in practice, briefly justify your answer (n=197) | Favorable approach | 80 (40.1) |
| Not favorable | 12 (6.1) | |
| Challenges described* | 29 (14.7) | |
| Not familiar with HPV self-sampling† | 60 (30.5) | |
| ‘No comment’ written | 2 (1.0) | |
| Don’t know | 4 (2.0) | |
| Unclear answer | 10 (5.1) | |
| Q47 Appropriate interactions to convert to telemedicine, other (n=5) | All of the above, but not in all cases | 1 (20.0) |
| Counselling and family meetings | 1 (20.0) | |
| Research-related activities | 1 (20.0) | |
| Follow-up any issues | 1 (20.0) | |
| Discuss treatment options | 1 (20.0) | |
| Q52 Duration of service interruption in practice/institution due to pandemic, before resumption (n=421) | No interruption | 47 (11.2) |
| <1 month | 41 (9.7) | |
| 1 month to <2 months | 51 (12.1) | |
| 2 months to <4 months | 104 (24.7) | |
| 4 months to <6 months | 47 (11.2) | |
| >6 months | 55 (13.1) | |
| Don’t know | 5 (1.2) | |
| Not applicable to my practice | 3 (0.7) | |
| Unclear answer | 68 (16.2) | |
| Q54 Measures implemented to catch up with cancellations/postponements, other (n=58) | Increased screening capacity (clinic space and staff) | 12 (20.7) |
| Prioritizing patients | 2 (3.4) | |
| Adapting and enforcing screening criteria | 3 (5.2) | |
| Allowing in-person screening | 3 (5.2) | |
| Contacting and rebooking patients | 6 (10.3) | |
| Telemedicine | 4 (6.9) | |
| Screening continued during COVID-19 | 2 (3.4) | |
| None | 21 (36.2) | |
| Unclear answer | 5 (8.6) | |
| Q60 Screening patients (with COVID-19) for cervical cancer, if yes, briefly describe the process of cervical cancer screening of COVID-19 patients’ (n=68) ‡ | Only those who are asymptomatic | 1 (1.5) |
| COVID-19 screening pre-appointment | 12 (17.6) | |
| Use of PPE | 3 (4.4) | |
| Deferral | 37 (54.4) | |
| Telemedicine | 1 (1.5) | |
| Regular practice | 7 (10.3) | |
| Not applicable to my practice | 3 (4.4) | |
| Unclear answer | 6 (8.8) | |
| Q61 Which cervical cancer screening guidelines has your practice/institution been following (n=422)‡ | Governmental | 268 (63.5) |
| Local/institutional | 19 (4.5) | |
| Professional association/society | 73 (17.3) | |
| Cancer organization/society | 10 (2.4) | |
| None | 13 (3.1) | |
| Don’t know | 11 (2.6) | |
| Not applicable to my practice | 4 (0.1) | |
| Unclear answer/acronym | 40 (9.5) |
-
*
Include cost and whether it will be funded by the government; the need to be added to the guidelines and endorsed by government and professionals along with having a well-designed program that helps with patient compliance and the need for professionals to be well educated on the subject; implementation challenges (including delays due to the pandemic, burnout, lack of available healthcare spending, lack of appropriate healthcare infrastructure, lack of prioritization of women’s health); patient education (awareness, proper technique given with clear simple instructions); and logistics (material currently not available or test not routinely offered, should kits be mailed to participants).
-
†
Respondents were either not familiar with the test itself, with whether the test is available, or with the test’s validity (in terms of its sensitivity and specificity).
-
‡
Frequency count exceeded number of respondents (68 respondents for Q60 and 422 respondents for Q61) as some provided more than one answer.
Additional files
-
Supplementary file 1
Pan-Canadian survey on the impact of the coronavirus disease 2019 (COVID-19) pandemic on cervical cancer screening and management.
Hard copy of the online survey instrument.
- https://cdn.elifesciences.org/articles/83764/elife-83764-supp1-v2.docx
-
Supplementary file 2
Tabulation of survey questions.
Includes frequency distribution of Q11-13 (2a), Q14-16 (2b), Q17-19 (2c), Q20-21 (2d), Q22-23 (2e), Q24-29 (2f), Q30-35 (2g), Q36-37 (2h), and Q38-Q42 (2i).
- https://cdn.elifesciences.org/articles/83764/elife-83764-supp2-v2.docx
-
MDAR checklist
- https://cdn.elifesciences.org/articles/83764/elife-83764-mdarchecklist1-v2.pdf
Download links
A two-part list of links to download the article, or parts of the article, in various formats.
Downloads (link to download the article as PDF)
Open citations (links to open the citations from this article in various online reference manager services)
Cite this article (links to download the citations from this article in formats compatible with various reference manager tools)
Pan-Canadian survey on the impact of the COVID-19 pandemic on cervical cancer screening and management: cross-sectional survey of healthcare professionals
eLife 12:e83764.
https://doi.org/10.7554/eLife.83764
