Strategies to Improve the Cervical Cancer Screening Experience of LGBTQ Patients: a Film-Based Curriculum

Abstract

Introduction: Reproductive health screenings, such as Papanicolaou (Pap) tests, are an essential aspect of preventative health that enable detection and treatment of precancerous cervical changes (i.e., dysplasia), ultimately resulting in prevention of cervical cancer. Despite being as likely to develop cervical cancer as heterosexual cisgender women, LGBTQ people with a cervix underutilize cervical cancer screening tests. There is a need to educate medical providers and trainees in order to improve the cervical cancer screening experience for LGBTQ patients and, ultimately, to increase rates of cervical cancer screening in this population. Methods: A participatory educational workshop was developed to permit medical trainees to practice challenging conversations and learn how to implement practical strategies to improve the cervical cancer screening experience for LGBTQ patients. The 1.5-hour session included: a 30-minute didactic presentation featuring the 10-minute film, We Are Not a Monolith, two 10-minute role play scenarios, a 25-minute large group discussion, and administration of pre- and post-session surveys to assess knowledge of and confidence level in providing cervical cancer screening to this population. In September 2017, the workshop was offered to learners at the GLMA: Health Professionals Advancing LGBT Equality (GLMA) Annual Meeting. In January 2018, the workshop was offered to Harvard Medical School (HMS) students at all levels of training. Results: There were 30 GLMA workshop participants. 26 out of 30 completed pre-workshop surveys, and 22 (73%) completed both a pre- and post-workshop survey. There were 12 HMS workshop participants, all of whom completed pre- and post-workshop surveys. The GLMA and HMS groups were analyzed separately. Comparing GLMA participants’ overall performance on the full set of knowledge questions using a composite Total Mean Knowledge Score, there was statistically significant improvement between the pre- and post-scores (p-value = 0.008). When comparing HMS participants’ composite pre- and post-workshop Total Mean Knowledge Score, improvement was noted, but statistical significance was not observed (p-value = 0.504). When comparing participants’ composite Total Mean Confidence Scores between the pre- and post-workshop, statistically significant improvement was observed for both the GLMA and the HMS group (p-value <0.001). Itemized and written feedback were obtained from both participant groups. Feedback was overwhelmingly positive with most participants (n=33, 97%) either agreeing or strongly agreeing about the appropriateness of teaching techniques utilized, and the workshop’s effectiveness in achieving the stated learning objectives. Discussion: The quantitative improvement in knowledge and confidence levels and positive feedback observed suggest that this workshop enables medical trainees to improve their knowledge, confidence and comfort with providing cervical cancer screening care to their LGBTQ patients.