GP CCE Cases · womens-health
Never-screened woman declines examination — CCE clinical encounter
CCE-style clinical encounter: a 38-year-old woman who has never screened due to past trauma declines speculum examination. The candidate must offer HPV self-collection with honest accuracy framing, address the 'worn out'/fear beliefs, safety-net symptoms, and build a follow-up plan she accepts.
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Prompt
A 38-year-old woman attends for contraception renewal. Records show no cervical screening ever. She had a traumatic speculum experience years ago and says screening is 'not happening today'. No abnormal bleeding or discharge. She smokes. Her sister was treated for 'pre-cancer cells' last year.
Objectives
- Explore her screening barriers without pressure, acknowledging the past experience as legitimate. [2]
- Offer self-collection accurately: what it tests (oncogenic HPV), its near-clinician sensitivity, and what it cannot do. [1]
- Explain why never-screened at 38 matters — persistent infection to cancer is the risk she carries. [2]
- Address smoking as an HPV-persistence factor and offer support without lecturing. [2]
- Agree a concrete follow-up structure including symptom safety-netting and result contact. [3]
References3ShowHide
- [1]Phillips SA et al. Accuracy of HPV Self-Collection Compared with Clinician-Collected HPV Testing and Cytology: A Meta-analysis. Obstetrics and gynecology, 2025.PMID 40643571
- [2]Sultana F et al. Uptake and performance of self-collection offered through primary care to all eligible participants in a national cervical screening programme in Australia: a retrospective cohort study. The Lancet. Public health, 2026.PMID 41611360
- [3]Verdoodt F et al. Reaching women who do not participate in the regular cervical cancer screening programme by offering self-sampling kits: a systematic review and meta-analysis of randomised trials. International journal of cancer, 2015.PMID 26296294