Researchers are looking for general practice nurses, other healthcare professionals and GP admin staff to participate in a study to investigate ways of improving uptake of the left lateral position (LLP) in cervical screening.
Since 2020, national guidelines have recommended offering everyone who attends for cervical screening a choice between the traditional position and LLP, but research suggests that patients are not aware of the LLP and clinicians are not offering it.
Traditional testing requires the patient to lie on their back with knees bent up and apart so the clinician can take a sample. Some people report they find the test degrading, embarrassing, anxiety provoking and uncomfortable. Also, people who have experienced sexual trauma report the test makes them feel vulnerable, and for cultural reasons, some women find that exposing their body parts leads to embarrassment and anxiety. These issues contribute to the reducing numbers attending screening.
In the LLP, the patient lies on their left side with their left leg straight out on the bed and the right leg bent up, similar to the ‘recovery position’, with their legs slightly apart, resting on the bed. The LLP is as effective, is less exposing and may be more comfortable, which may encourage more people to attend screening.
The objective of the CLEAR study is to implement a cervical screening programme that provides patient choice of test positions (including the LLP), to identify individual and system level challenges and facilitators to implementation; and to assess impact on patient uptake, inclusivity and acceptability.
Research lead Dr Zoe Anchors explained: ‘We will evaluate how introducing the LLP works in practice, asking what works, for whom, how and why.’
There are three phases:
Phase 1: We are undertaking co-design workshops to create information about screening choice, ensuring the language is accessible and acceptable, and to determine how people would like to receive information from their practice. We are investigating any challenges to implementing LLP in practice
Phase 2: Evidence review and focus groups to develop early understanding of how LLP may work in practice. We will discuss the evidence around position choice in cervical screening in two focus groups: one, involving 10 healthcare professionals who regularly perform cervical screening in primary care, and two, 10 people eligible for screening.
Phase 3: Working with 10 GP sites over a 6-month period to test whether supporting them to inform patients of their screening choices, and helping clinicians to offer the new position, encourages more people to be screened, choose their position and improves patient experience.
‘We expect about 2800 people to attend screening during this time. We will collect data from the practice regarding screening uptake and position before we start the study, and then again at the end to see how our research influences screening in practice. We will also survey attendees to understand their experience and interview some staff and patients to understand if/how/why the test works in practice.’
The research project will last for 36 months (August 2024 – July 2027). The first focus groups will be conducted between April – May 2025 and work with GP sites will take place between August 2025 – March 2027.
At the end of the study, the CLEAR team will distribute study summaries and make its patient resources freely available. The team will also produce information for health decision makers to help them understand how screening choice works in practice.
Are you a healthcare professional involved in cervical screening? If so, we are looking for participants to join our online focus groups. To get involved or for more information about the wider project, please contact the CLEAR team at clear.study@uwe.ac.uk or call Dr Zoe Anchors on 0117 328 1882.
