Woman Rewrites Her Cervical Screening Letter, Urges NHS To Change Its Language

Edana Minghella pointed out smear teats can be physically and physiologically painful for some women.
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A woman has urged the NHS to change the language it uses when reminding patients to attend cervical screening, pointing out that the test is not straightforward for everyone.

Edana Minghella shared a letter she received from her GP surgery telling her she had “failed to respond to invitations for routine screening” – then posted a suggested rewrite.

“I’m sharing this because I know I’m not the only one. Dear primary care services, please think about how you communicate with women about #cervicalscreening,” she said on Twitter.

I’m sharing this because I know I’m not the only one.

Dear primary care services please think about how you communicate with women about #cervicalscreening.

Letter sent to me in pic, and my suggested version in next pic. pic.twitter.com/wTMIxinUWH

— Dr Edana Minghella (@edanaming) September 16, 2019

Cervical screening can save lives by detecting abnormal cells that may later lead to cancer, meaning women or trans men who have not have a total hysterectomy can be monitored and access treatment sooner. But the test isn’t easy for everyone.

“While for many it is a straightforward test, for others cervical screening can be difficult,” Kate Sanger, head of communications at Jo’s Cervical Cancer Trust previously told HuffPost UK. “This can include survivors of sexual violence, women with conditions such as vaginismus and those who are affected by anxiety or PTSD.”

The original letter Minghella received told her if she did not wish to take part in the screening programme, she would “need to fill in a disclaimer to this effect”. The letter did not address any potential reasons for avoiding screening.

North Hollywood, California, USA.
Angela Wyant via Getty Images
North Hollywood, California, USA.

Minghella, a jazz singer from South East England, told HuffPost UK the tone of the letter made her feel like she’d been told off.

“I felt annoyed and embarrassed when I received the letter. Annoyed at its tone, frustrated that they can’t see that there is a serious issue here,” she said. “I felt embarrassed because I suppose I see myself as a ‘compliant’ patient and here I was, exposed as non-compliant.”

The last time she attended screening she found the smear test extremely painful and had to stop mid-way through the appointment, she explained.

“The nurse was herself embarrassed and troubled, so much so that she stopped the procedure and told me to go home and not to worry about it. She too had clearly not had any training in how to support women through this.”

The letter Edana Minghella received from her GP surgery.
Edana Minghella
The letter Edana Minghella received from her GP surgery.

In contrast to the NHS letter, Minghella’s suggested rewrite reads: “We would like to encourage you to attend, but we do understand that many women find the screening difficult or painful for all sorts of reasons.

“If you would like to talk in confidence to a doctor or nurse about how we can help make the procedure as painless and psychologically safe for you as possible, please do get in touch so we can arrange an appointment.”

The suggested rewrite.
Edana Minghella
The suggested rewrite.

Almost 1,000 people have liked her post on Twitter, with dozens commenting to say they think a kinder approach would encourage a greater uptake for cervical screening, which is currently at a 19-year-low.

Thanks for this. My first, unsuccessful smear was very traumatic & it will take a lot for me to go back for another. A letter like this would just make me feel guilty & make it so much harder to go back.

— Jessica Jones (@Jeyssika) September 16, 2019

Completely agree with you Edana. Health communications particularly addressed to women leave a lot to be desired. You can see the same sort of approach with breast screening. Don’t get me started!

— Sue Wright 🌱 (@firstintheQ) September 16, 2019

Your version is so much more encouraging than theirs. My mother went once decades ago and never again. Luckily she's been fine but if they had given her a chance to explain why she didn't attend and they rectified, it maybe she could have been persuaded to attend again.

— Biggie and Heidi (@biggie_and) September 16, 2019

Totally agree that communication itself can be a barrier to attending. There's a balance to be hit between professional and encouraging & I think there's work to be done in to ensure the entire process can support it.

— Lauren McKechnie (@teammckechnie) September 16, 2019

There are many reasons why people may avoid cervical screening – and judgmental language does not help.

The charity My Body Back supports women who have experienced sexual assault to access cervical screening and you can follow @AtYourCervix_x for peer support if you’re finding cervical screening difficult. You’ll find more resources and advice from Jo’s Cervical Cancer Trust or from your GP.

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