Overview
Initiative type
Model of Care
Status
Deliver
Published
June 2026
Summary
Ipswich Gynaecology Working Party has systematically developed and published the world's first-ever patient decision aid (PDA) for modern cervical screening, which may improve the screening participation.
Dates: March 2023 - February 2026
Implementation sites: Townsville University Hospital
Partnerships: Ipswich Hospital Foundation (Vicki Doig Research Scholarship 2023), University of Queensland, WM Research Innovation Support Unit
Aim
To develop, validate, and evaluate a patient decision aid (PDA) to support informed choice between clinician-collected and self-collected cervical screening, with potential for adoption within the National Cervical Screening Program.
Outcomes
This IPDAS-compliant decision aid supports informed choice in modern cervical screening and may enhance screening participation without bias toward a specific collection method. According to unpublished data of the Phase 5, a significantly greater number of women would book a cervical screening test, if they read the PDA in comparison to the routine invitation letter. They preferred PDA to be sent to screening eligible women with the routine invitation letter. A vast majority of study participants said that they will attend their future cervical screening. This PDA has potential for integration into national cervical screening program in Australia and other countries.
Background
Most cervical cancers occur in women who are overdue for screening. Women who are regularly screened have a substantially lower risk of advanced cervical cancer, which is often incurable. Self-collection of vaginal samples reduces several barriers associated with clinician-collected cervical screening and has been shown to improve participation.
Since October 2022, Australia has offered self-collection as an option to all eligible women. However, there is no consumer-friendly PDA comparing the risks and benefits of clinician-collected versus self-collected screening tests, which may hinder informed
decision-making.
Methods
The decision aid was developed in accordance with the International Patient Decision Aid Standards (IPDAS) and its quality criteria, using a multi-phase mixed-methods design.
Phase 1 involved a comprehensive literature review, synthesising evidence on cervical screening, self-collection efficacy, awareness, and women’s decision-making needs.
Phase 2 employed mixed-methods research, including focus groups, to explore women’s perspectives on screening choices; this identified limited awareness of self-collection and a lack of clear comparative information.
Phase 3 involved iterative co-design with a multidisciplinary steering group, refining content, layout, and readability.
Phase 4 consisted of field testing the decision aid with a larger cohort of women (n = 360) to assess clarity, usability, and acceptability, followed by further revisions.
Phase 5 involved an evaluation of the potential impact of the PDA. Please find a more information in our published paper: https://www.ejgo.net/articles/10.22514/ejgo.2024.119
Discussion
Participants reported that the decision aid was easy to understand, balanced, and helpful in supporting informed choice. Importantly, preferences remained diverse, with many women still choosing clinician-collected screening, suggesting the decision aid was not biased toward self-collection. Feedback indicated improved confidence in decision-making and greater intention to participate in cervical screening.
There are limitations to our patient decision aid. While cervical screening is recommended for all women aged 25-74, our field testing extended only to women who were referred to our Gynaecology Outpatient Clinic, meaning they were engaged with a clinician in the community and more likely to get a cervical screening test before answering the questionnaire. Consequently, we recommend extending this study to the general population. In addition, some of these women had abnormal results in the past and thus may have higher health literacy on the topic. Similarly, we are unable to report on the diversity of the sample used in field testing, except for age.
References
1. Carla Pecoraro, Lilantha Wedisinghe, Jeevan Jangam, Gabrielle Dore, Cassandra Harrison, Gary Chan, et al. Development and pilot evaluation of a decision aid for modern cervical screening. European Journal of Gynaecological Oncology. 2024; 45(6): 81-89.
2. Witteman HO, Maki KG, Vaisson G, Finderup J, Lewis KB, Dahl Steffensen K, et al. Systematic development of patient decision aids: an update from the IPDAS collaboration. Medical Decision Making. 2021; 41: 736-754.
3. Landy R, Sasieni PD, Mathews C, Wiggins CL, Robertson M, McDonald YJ, et al. Impact of screening on cervical cancer incidence: a population-based case-control study in the United States. International Journal of Cancer. 2020; 147: 887-896.
Key contact
Dr Lilantha Wedisinghe
Senior Staff Specialist
Ipswich Hospital