Supplementary Material for: Redefining Cytotechnologist Practice in Sweden: National Survey on Workload, Expanded Roles, and Future Competency Needs

Abstract
Introduction:
Cytotechnologists have long been central to cervical cancer screening, although their education and job responsibilities differ markedly across countries. The adoption of primary HPV testing has substantially reshaped cytotechnology workforce needs and professional roles. In Sweden, however, no comprehensive overview of these changes exists. This study therefore examined cytotechnologists’ training, job tasks, and how HPV testing has affected their daily work and practice patterns.
Methods:
We conducted a nationwide survey of Swedish cytology laboratories using an electronic questionnaire developed by the Board of the Swedish Society of Cytotechnologists. The 84‑item instrument addressed workload, diagnostic tasks, ancillary testing, digital cytology, job satisfaction, and managerial assessments. Responses were summarized descriptively.
Results:
Screening of gynecologic (86%) and non‑gynecologic specimens (89%) remained widely practiced among cytotechnologists, together with involvement in rapid on‑site evaluation (48%), quality assurance activities (41%), and fine‑needle aspiration assessment (55%). The transition to HPV‑primary screening was associated with reductions exceeding 50% in cervical cytology volumes and contributed to marked workforce pressures; 30% cytotechnologists reported assuming novel responsibilities, 81% of laboratories reported recent cytotechnologist attrition, whereas only 15% anticipated new recruitment. Adoption of digital cytology remained limited (6%), and no laboratory reported the use of artificial intelligence–based tools. Interest in expanded professional roles was high among cytotechnologists (93%) and was substantially supported by managers (88%). Concerns regarding job satisfaction were evident, with 19% of cytotechnologists indicating an intention to leave their position within the forthcoming year.
Conclusion:
Sustaining cytology services will require proactive workforce planning, competency‑based upskilling, role diversification, and strategic adoption of digital technologies.