Rachel L. Winer, PhD
University of Washington
School of Public Health
Department of Epidemiology
Diana S.M. Buist, PhD, MPH
Kaiser Permanente Washington Health Research Institute
Designing & Testing the Future of Home-based Cervical Cancer Screening: Results from a Collaborative Academic-Embedded Delivery System Pragmatic Randomized Trial
Embedded pragmatic clinical trial; Cervical cancer screening; Human papilloma virus
- The aim of the Home-Based Options to Make Screening Easier (HOME) pragmatic randomized trial was to compare the effectiveness of 2 approaches to increasing cervical cancer screening among women 30-64 years of age who are overdue for cervical cancer screening.
- Challenges of embedded pragmatic trials reported by the study team include:
- Discussions with lab, primary care, OB/GYN, and prevention and outreach teams
- Negotiation about the target population
- Aligning with evolving clinical guidelines
- Engaging multiple clinical champions
- Extensive back and forth with IRB for approval
- The study team also conducted semi-structured interviews to understand women’s attitudes, emotional responses, and informational needs after receiving a positive kit result and completing recommended follow up.
Were you able to assess the impact of this intervention on the clinic staff?
To help move the field forward, there is a need for more publications and more education of peer reviewers and funders about the challenges of conducting embedded pragmatic trials.
Read more about the HOME pragmatic trial design and suggestions for how to improve the promise of embedded pragmatic trials.