Gynaecologists' Views and Acceptability of Active Surveillance for Women Diagnosed With Cervical Intraepithelial Neoplasia 2: A Qualitative Study

BACKGROUND: Persistent oncogenic HPV infection can cause cervical epithelial changes leading to premalignant lesions such as CIN2. Active surveillance, a conservative option, reduces exposure to excisional risks while allowing timely treatment when needed. However, little is known about clinicians' perspectives, acceptability, and experience of offering active surveillance in the Australian healthcare context. AIMS: To explore gynaecologists' perspectives, acceptability, and experiences in providing active surveillance to women diagnosed with CIN2. MATERIALS AND METHODS: Individual semi-structured interviews were conducted with obstetrics and gynaecology specialists and trainees in secondary and tertiary healthcare settings across Australia. Data were analysed using inductive thematic analysis. RESULTS: Twenty-five in-depth interviews were conducted. Participants expressed positive views about active surveillance, regarding it as a safe option that does not increase long-term cancer risk. When formulating management recommendations for CIN2, participants considered various interrelated diagnostic, patient, clinician, and policy-level factors. To support shared decision-making, participants used several communication strategies such as anatomical models and visual images to help address patient knowledge gaps and they provided patients with time and space to reflect on their preferred management plan. Participants identified strategies that could support offering active surveillance and patients' adherence to this, including enhanced clinician education and training, increased resourcing, and improved use of information technology to support follow-up tests for active surveillance. CONCLUSIONS: A deeper understanding of multi-level factors influencing clinicians' recommendations and implementation of active surveillance for CIN2 may inform the development of targeted interventions to address barriers and strengthen enablers, ultimately supporting wider offering of active surveillance.