Table 2.
Definitions and rates of inadequate follow up
| Reference | Definition of inadequate follow-up | According to guidelines | Guidelines used for follow-up | Timeframe for follow up | Source used as evidence of follow-up | Study patient follow-up method | Rates of inadequate follow-up |
|---|---|---|---|---|---|---|---|
| Benard (2005) [21] |
Inadequate follow up: Women with a 3rd Pap after two abnormal Pap tests No follow up: No test after two abnormal Pap tests |
Y | National Cancer Institute (NCI) interim guidelines (1994) | 2 years after second abnormal Pap test |
National Breast and Cervical Cancer Early Detection Program (NBCCEDP) database |
N/A | Inadequate follow up: 28.3% No follow up: 27.7% |
| Breitkopf (2014) [22] |
Failure to attend follow-up appointment Delay to attend Follow-up appointment (over 90 days) |
Y | The optimum organization for the delivery of colposcopy service in Ontario: A systematic review. Journal of Lower Genital Tract Disease. (2010) | 90 days from scheduled appointment and 18 months following abnormal test result for completeness of care | Prospective electronic medical record (EMR) review | Phone |
Failure to attend: Active control: 25% Usual Care: 24% Standard care: 22% (p = 0.93) Delay in care (days) total: Intervention 58 +-75 Active Control: 69 + -72 Standard care: 54 + -75 (p = 0.75) |
| Brewer (2021) [23] | Failure to attend follow-up of HPV | Y | National Screening Guidelines (NSG) for cervical screening in New Zealand (2008) | Unclear for colposcopy (3 months for HPV screening) | Results mailed to study directly and other information obtained from National Cervical Screening Program Register and EMR | Mixed (In person or phone) | 8% (2/24) |
| Chase (2012) [24] | No follow-up visit | Y | American Society of Colposcopy and Cervical Pathology (ASCCP) guidelines (2007) | 2.5 to 14 months from initial appointment | Retrospective chart and/or EMR review | Mixed (phone and mail) | 50% no-show rate |
| Dunn (2013) [25] | No consultation note or chart notation indicating a colposcopy visit | N | (-) | Six months and one day from referral date | Retrospective chart review | Phone | 13% pre group 4% post group (p < 0.001) |
| Engelstad (2005) [26] | No repeat Pap smear and/or a colposcopy examination was performed | Y | Alameda County Medical Centre’s (ACMC’s) Highland Hospital (HGH) Guidelines | 6 months period after her initial abnormal Pap smear | A centralized computerized tracking follow-up system (with information from the clinics computerized appointment system, clinics reports, and patients’ medical records | Mixed (In person or phone) | 18% intervention (hosp) 20% control (primary care) |
| Felix (2009) [27] | Client self-report of not receiving care from a family planning (FP) provider or receiving elsewhere | N/A | (-) | N/A | Study Survey | Self-report | According to a patient survey 63.2% reported no treatment by a FP provider. Of those, 49.3% were not referred by a FP provider for follow-up |
| Fish (2013) [28] | Non-attendance to their scheduled appointment | N | (-) | N | Electronic clinic appointment logs | Mixed (Phone and mail) | N/A (population was non-adherent) |
| Gok (2010) [29] | A “non-attendee” was defined as a woman who neither responded to the regular invitation nor to a standard reminder | Y | Netherlands National Screening Program (2007) | 6 months from invitation or reminder to attend follow up | Receipt of informed consent plus self-samples and Nationwide pathology database (PALGA) |
Intervention group: 5.5% to 61.5% (depending on stage to follow up (from repeat HPV and Pap to colposcopy) |
|
| Goldsmith (2008) [30] | N/A | N/A | (-) | N/A | Women with a colposcopy appointment: List identified by clinic and waiting room recruitment | Mixed (Invitation package through clinic and phone) | N/A: Qualitative study on experiences with cervical screening communication |
| Gultekin (2018) [31] | Unclear | Y | Türkiye National Screening Program | Unclear | Regional clinics medical records | Mixed (Phone, mail and in person) | Not Reported |
| Hui (2014) [32] | Unclear | N/A | (-) | N/A | N/A | N/A Cross sectional studies about barriers to follow-up before their colposcopy appointment | |
| Hunt (2002) [33] | Failure to attend a colposcopy appointment after 3 reminders, the last and 4th by certified letter | Y | Breast and Cervical Cancer Control Program Guidelines based on American Cancer Society Guidelines (1992) | N | Clinics’ records | Mixed (Phone, mail and in person) | N/A Qualitative study on factors affecting incomplete follow-up |
| Kristiansen (2017) [34] | No new cervical cytology or histology was registered after recommended follow-up | Y | Danish National Screening Programme and follow-up recommendations | 6 months after reminder follow- up depending on period of recommendation (Within 3 m, at 3, 6, 9 and 12 months from initial cytology) |
Danish Pathology Data Bank (DPDB) |
N/A |
6 months (before) 64% (After) 62% (OR: 0.94 (0.90 to 0.97)) 3 months: (before) 62% (after) 60% (OR: 0.94 (0.90 to 0.97)) Within 3 months, (before) 16% (after) 16% (OR: 0.99 (0.95 to 1.02)) |
| Kristiansen (2019) [35] | Absence of a new cervical cytological or histological sample (i.e. including biopsies) at different relevant time points | Y | Danish National Screening Programme and follow-up recommendations | 3, 6 or 12 months after initial cytology |
Danish Pathology Data Bank (DPDB) |
No timely follow up 47.2% (control) No timely follow up 42.9% (intervention) (p < 0.005) No follow up one month after recommended 35.0% (control) No follow up one month after recommended (intervention) 31.4% (p < 0.005) |
|
| Kupets (2014) [36] a | Direct colposcopy without repeat cytology (inadequate) OR no evidence of colposcopy after cytology (inadequate). Lost to follow up: No colposcopy nor cytology | Y |
National Health Service Cancer Screening Programmes Cervical Screening Call and Recall: Guide to Administrative Good Practice. (Canada 2014) |
After 2 years after initial high grade Pap test |
Cytobase (CytoBase has information on cervical cytology smears performed in community-based settings) |
In person |
Inadequate follow up: Cytology and no colp: ASCUS: 48.3% LSIL: 30.1% Colp and no repeat cytology: ASCUS: 15.7% LSIL: 26% Lost to follow-up: No cytology nor colposcopy ASCUS: 12.8% LSIL: 11.1% |
| Lindau (2006) [37] |
Loss to follow up: No visit on chart review Inadequate follow up: Visit within a year of index Pap |
N | (-) | Within a year of index Pap (Recommendation: 3 to 6 months depending on type of lesion) | Chart abstraction | Mixed (phone, mail and in person) |
Lost to follow-up: 25% Followed within a year: 75% |
| Loopik (2020) [38] | Inadequate follow-up measured as a dichotomy (yes/no to having subsequent test (Yes/No) | Y | National Monitoring Cervical Cancer Screening (Netherlands/Dutch National Guidelines) | N | Nationwide network and registry of histo-and cytopathology in the Netherlands (PALGA) | N/A |
No initial follow-up after abnormal test result: 8.1% No further follow-up after referral for colposcopy in clinician sampled group: 26% No further follow-up after referral to colposcopy in self sample group: 55.5% |
| Oladipo (2007) [39] | Failure to attend/cancelled to attending colposcopy appointment | N | (-) | N | Attendance, cancellation, and failure to attend were record by study | Phone |
Appointment cancellation: Intervention: 7% Control: 18% Non-attendance: Intervention: 10% Control 24% |
| Percac-Lima (2013) [40] | Failure to attend appointment at Colposcopy clinic | Unclear | (-) | N | EMR chart review | Mixed (phone, visit and in person) |
Control arm: 2004–2007 = 18.6% 2008–2011 = 20.6% (p= 0.45) Intervention: 2004–2007 = 19.8% 2008–2011 = 15.7% (p= 0.024) |
| Peterson (2003) [41] | Lack of a subsequent cervical cytology or pathology specimen within four months | Y | Definition operationalized by the study using various sources | 4 months of the initial abnormal specimen for a high-grade lesion (HGSIL) or within seven months for a low-grade lesion (ASCUS, AGUS, or LGSIL). | Academic medical centre’s computerized pathology database | N/A | Inadequate follow-up: 38% |
|
Salyer 2021 [42] b Salyer 2022 [47] b |
Self-reported: “Did you get the recommended follow-up after your Pap test” | N | (-) | N | Study Survey | Self-report | 31% (18/58) |
| TOMBOLA Group (2009) [43] | Cytology surveillance non-attenders: if they did not attend for a cytology test or attended more than six months after it was due. In the immediate colposcopy arm, non-attenders failed to attend the two appointments offered | Y | National Health Service (NHS) Screening and follow-up Guidelines | 6 months from recommended follow-up | Trial data-base and women medical records, together with hospital and pathology databases | In person | Non-attendance: Cytological surveillance arm 10.6% Immediate colposcopy: 6.8% |
| Tse (2016) [44] | Patients who did not attend cervical smear screening | Unclear | (-) | 3 months from scheduled follow-up | Patients records and retrospective database review (Woo Women's Diagnostic and Treatment Centre (WDTC) | N/A | 41.8% did not attend > = 1 follow-up screening. 20.7% did not return for follow-up |
| UshaKiran (2002) [45] | Failure attend colposcopy appointment | N | (-) | No | Clinic’s computer database | N/A | 5.4% (37/685) |
| Valdini (2001) [46] | Unclear | Unclear | (-) | Unclear | Chart review | N/A | Lost to follow-up: 5.8% in control group (3/52) |
aOutcome data extracted for patients > 20 years old only
bStudy described in two publications
NR Not reported