1
|
Ilic I, Babic G, Dimitrijevic A, Grujicic Sipetic S, Ilic M. Predictors of Anxiety Before and After Diagnostic Procedures in Women with Abnormal Papanicolaou Smear in Cervical Cancer Screening Program. Behav Med 2024; 50:118-129. [PMID: 36268786 DOI: 10.1080/08964289.2022.2132202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 11/02/2022]
Abstract
Anxiety is one of the most common causes of withdrawal from follow-up among women with abnormal Papanicolaou screening results. The purpose of this study was to investigate predictors of anxiety in women with abnormal Papanicolaou smear in cervical cancer screening program. A population-based, cross-sectional study concerning the factors related to anxiety was carried out during 2017 in a cohort of women (N = 172) with positive Papanicolaou screening test before and after diagnostic procedures (colposcopy/biopsy/endocervical curettage) at one university Clinical Center in Serbia. Women completed a socio-demographic questionnaire and scale concerning anxiety (Hospital Anxiety and Depression Scale, subscale HADS-Anxiety) immediately before and 2-4 weeks after the diagnostic procedures. Multivariate logistic regression was applied in the data analysis. In our study, 35.2% (n = 52) of women had abnormal anxiety scores before the diagnostic procedures and 40.1% (n = 69) after the diagnostic procedures. Predictors of anxiety before diagnostic procedures were family history of noncervical gynecological cancers, higher level of worry and high burden of depressive symptoms. Significant independent predictors of anxiety after diagnostic procedures in women were rural residence, tension and discomfort during medical procedures, and less satisfaction with information/support. Although there was no significant difference in the prevalence of anxiety before and after diagnostic procedures in women with abnormal Papanicolaou screening results, results of this research will enable doctors to successfully make decisions concerning timely psychological support for women with positive screening test for cervical cancer that is necessary to decrease anxiety in our population.
Collapse
Affiliation(s)
- Irena Ilic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Goran Babic
- Department of Gynecology and Obstetrics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Aleksandra Dimitrijevic
- Department of Gynecology and Obstetrics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | | | - Milena Ilic
- Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| |
Collapse
|
2
|
Hecken JM, Halagiera P, Rehman S, Tempfer CB, Rezniczek GA. Virtual Reality for Anxiety Reduction in Women Undergoing Colposcopy: A Randomized Controlled Trial. J Low Genit Tract Dis 2023; 27:223-229. [PMID: 37166026 DOI: 10.1097/lgt.0000000000000745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To test whether headset-delivered virtual reality (VR) content affects satisfaction and/or anxiety in women with cervical squamous intraepithelial lesions undergoing colposcopy and colposcopically guided cervical biopsy. METHODS In this single-center, randomized trial, the authors measured overall satisfaction (100-mm visual analog scale) and situation-specific anxiety (STAI-S) in 247 women with suspected cervical squamous intraepithelial lesions wearing either no VR headset (arm 1, control) or a VR headset before (arm 2) or before and during colposcopy (arm 3). Secondary endpoints were pain, discomfort, and anxiety during colposcopy, heart rate, and 72-hour follow-up parameters: overall satisfaction, bleeding severity, bleeding duration, pain, and use of analgesics. Analysis was by intention to treat. RESULTS Median values for overall satisfaction were 100 (interquartile range, 90-100) in controls (n = 83), 100 (95-100) in arm 2 (n = 82), and 100 (95-100) in arm 3 (n = 82), respectively ( p = .92). The median Δ of situational anxiety (baseline vs after colposcopy) was -8 (-13 to -3), -8 (-16.5 to -4), and -10 (-20.5 to -4.5), respectively ( p = .09). The secondary endpoints pain during colposcopy (20 [10-50] vs 20 [10-40] vs 30 [10-50]; p = .65), discomfort during colposcopy (30 [10-50] vs 30 [10-50] vs 20 [10-50]; p = .46), and anxiety during colposcopy (20 [0-50] vs 10 [0-40] vs 10 [0-30]; p = .44), were not different between arms. Follow-up data showed no improvement in the 2 VR arms compared with controls (overall satisfaction, p = .37; bleeding severity, p = .09; pain level, p = .89; duration of pain; p = .23; and use of analgesics; p = .39). Per-protocol analysis did not change the results. CONCLUSIONS A VR headset showing a 360-degree surround vision film has no effect on satisfaction or anxiety in women undergoing colposcopy.
Collapse
Affiliation(s)
- Julia M Hecken
- Department of Obstetrics and Gynecology, Marien Hospital Herne, Ruhr-Universität Bochum, Herne, Germany
| | | | | | | | | |
Collapse
|
3
|
Hansen J, Kirkegaard P, Folmann B, Bungum HF, Hammer A. "I feel reassured, but there is no guarantee." How do women with a future childbearing desire respond to active surveillance of cervical intraepithelial neoplasia grade 2? A qualitative study. Acta Obstet Gynecol Scand 2022; 101:616-623. [PMID: 35383881 DOI: 10.1111/aogs.14354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/23/2022] [Accepted: 03/20/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In Denmark, women with a future childbearing desire diagnosed with cervical intraepithelial neoplasia grade 2 (CIN2) are recommended active surveillance instead of excisional treatment. However, we have limited and contradictory knowledge about how active surveillance of CIN2 may affect women emotionally. The aim of this study was to explore thoughts and emotional responses in women undergoing active surveillance of CIN2 and to explore how active surveillance may affect women's future childbearing desire. MATERIAL AND METHODS This qualitative study was conducted in the gynecological outpatient clinic, the Department of Obstetrics and Gynecology, Gødstrup Hospital, Denmark. Women of childbearing age undergoing active surveillance with colposcopy, biopsy and smear every 6 months due to CIN2 were eligible for enrollment. In-depth semi-structured interviews were conducted. The interviews were audiotaped and transcribed verbatim. A thematic analysis was performed using a phenomenological approach. RESULTS A total of 20 women were included. All women experienced nervousness and anxiety when they were diagnosed with CIN2 initially. Their main concern was whether they had cancer. Most women carried on with their everyday lives with only minor occasional worries about CIN2, often prompted just before check-up. However, some women were particularly nervous and found the period between check-ups frustrating and challenging. Women did not want to postpone their plans for pregnancy because of CIN2, but experienced the worries and check-ups associated with active surveillance as disruptive elements in their family planning. Women preparing for fertility treatment had their startup unnecessarily delayed due to active surveillance of CIN2, as clinical guidelines were inconsistent across subspecialties. Various factors influenced women's emotional well-being: life circumstances, information needs, and mental and physical discomfort during colposcopic examination. CONCLUSIONS Women felt that worries and check-ups due to active surveillance of CIN2 were disrupting elements in their family planning, although they did not affect their every-day life. Some women, however, were particularly anxious, demonstrating the importance of including women's experiences and preferences in clinical counseling. The fact that fertility treatment was delayed due inconsistent guidelines across subspecialties, suggests a need for a revision of current guidelines.
Collapse
Affiliation(s)
- Joan Hansen
- Gødstrup Hospital, NIDO Denmark, Gødstrup, Denmark
| | - Pia Kirkegaard
- Department of Public Health Programs, University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
| | - Birgitte Folmann
- Gødstrup Hospital, NIDO Denmark, Gødstrup, Denmark.,University College South Denmark, Kolding, Denmark
| | | | - Anne Hammer
- Gødstrup Hospital, NIDO Denmark, Gødstrup, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
4
|
The intelligent knife (iKnife) and its intraoperative diagnostic advantage for the treatment of cervical disease. Proc Natl Acad Sci U S A 2020; 117:7338-7346. [PMID: 32179675 PMCID: PMC7132269 DOI: 10.1073/pnas.1916960117] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Clearance of surgical margins in early cervical cancer prevents the need for adjuvant chemoradiation and associated morbidity and allows fertility preservation. Clearance of disease is also crucial in the surgical management of local recurrence of cervical tumors with exenterative surgery. In this study intelligent knife technology was able to discriminate healthy from abnormal lesions on the cervix with high accuracy, highlighting the potential to improve intraoperative management of women treated surgically for cervical cancer and, as a result, patient outcomes. While pilot experiments in vivo are encouraging, accuracy remains to be validated in larger patient cohorts. Future studies could also explore whether this technology could be used for management of cervical preinvasive disease. Clearance of surgical margins in cervical cancer prevents the need for adjuvant chemoradiation and allows fertility preservation. In this study, we determined the capacity of the rapid evaporative ionization mass spectrometry (REIMS), also known as intelligent knife (iKnife), to discriminate between healthy, preinvasive, and invasive cervical tissue. Cervical tissue samples were collected from women with healthy, human papilloma virus (HPV) ± cervical intraepithelial neoplasia (CIN), or cervical cancer. A handheld diathermy device generated surgical aerosol, which was transferred into a mass spectrometer for subsequent chemical analysis. Combination of principal component and linear discriminant analysis and least absolute shrinkage and selection operator was employed to study the spectral differences between groups. Significance of discriminatory m/z features was tested using univariate statistics and tandem MS performed to elucidate the structure of the significant peaks allowing separation of the two classes. We analyzed 87 samples (normal = 16, HPV ± CIN = 50, cancer = 21 patients). The iKnife discriminated with 100% accuracy normal (100%) vs. HPV ± CIN (100%) vs. cancer (100%) when compared to histology as the gold standard. When comparing normal vs. cancer samples, the accuracy was 100% with a sensitivity of 100% (95% CI 83.9 to 100) and specificity 100% (79.4 to 100). Univariate analysis revealed significant MS peaks in the cancer-to-normal separation belonging to various classes of complex lipids. The iKnife discriminates healthy from premalignant and invasive cervical lesions with high accuracy and can improve oncological outcomes and fertility preservation of women treated surgically for cervical cancer. Larger in vivo research cohorts are required to validate these findings.
Collapse
|
5
|
Hilal Z, Alici F, Tempfer CB, Rath K, Nar K, Rezniczek GA. Mozart for Reducing Patient Anxiety During Colposcopy. Obstet Gynecol 2018; 132:1047-1055. [DOI: 10.1097/aog.0000000000002876] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
6
|
de Kok IMCM, Korfage IJ, van den Hout WB, Helmerhorst TJM, Habbema JDF, Essink-Bot ML, van Ballegooijen M. Quality of life assumptions determine which cervical cancer screening strategies are cost-effective. Int J Cancer 2018; 142:2383-2393. [PMID: 29349795 DOI: 10.1002/ijc.31265] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 12/07/2017] [Accepted: 01/03/2018] [Indexed: 11/07/2022]
Abstract
Quality-adjusted life years are used in cost-effectiveness analyses (CEAs). To calculate QALYs, a "utility" (0-1) is used for each health state induced or prevented by the intervention. We aimed to estimate the impact of quality of life (QoL) assumptions (utilities and durations of health states) on CEAs of cervical cancer screening. To do so, 12 alternative sets of utility assumptions were retrieved from published cervical cancer screening CEAs. Two additional sets were based on empirical QoL data that were integrally obtained through two different measures (SF-6D and EQ-5D) from eight groups of women (total n = 3,087), from invitation for screening to diagnosis with cervical cancer. Per utility set we calculated the number of quality-adjusted days lost (QADL) for each relevant health state in cervical cancer screening, by multiplying the study-specific assumed disutilities (i.e., 1-utility) with study-specific durations of the loss in QoL, resulting in 14 "QADL-sets." With microsimulation model MISCAN we calculated cost-effectiveness of 342 alternative screening programs (varying in primary screening test [Human Papillomavirus (HPV) vs. cytology], starting ages, and screening interval) for each of the 14 QADL-sets. Utilities used in CEAs appeared to differ largely. We found that ten QADL-sets from the literature resulted in HPV and two in cytology as preferred primary test. The SF-6D empirical QADL-set resulted in cytology and the EQ-5D one in HPV as preferred primary test. In conclusion, assumed utilities and health state durations determine cost-effectiveness of cervical cancer screening. Also, the measure used to empirically assess utilities can be crucial for CEA conclusions.
Collapse
Affiliation(s)
- Inge M C M de Kok
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Wilbert B van den Hout
- Department of Medical Decision Making, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Theo J M Helmerhorst
- Department of Gynaecology and Obstetrics, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - J Dik F Habbema
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Marie-Louise Essink-Bot
- Department of Public Health, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Marjolein van Ballegooijen
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| |
Collapse
|
7
|
O'Connor M, O'Brien K, Waller J, Gallagher P, D'Arcy T, Flannelly G, Martin CM, McRae J, Prendiville W, Ruttle C, White C, Pilkington L, O'Leary JJ, Sharp L. Physical after-effects of colposcopy and related procedures, and their inter-relationship with psychological distress: a longitudinal survey. BJOG 2017; 124:1402-1410. [PMID: 28374937 DOI: 10.1111/1471-0528.14671] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To estimate prevalence of post-colposcopy physical after-effects and investigate associations between these and subsequent psychological distress. DESIGN Longitudinal survey. SETTING Two hospital-based colposcopy clinics. POPULATION Women with abnormal cytology who underwent colposcopy (±related procedures). METHODS Questionnaires were mailed to women 4, 8 and 12 months post-colposcopy. Details of physical after-effects (pain, bleeding and discharge) experienced post-colposcopy were collected at 4 months. Colposcopy-specific distress was measured using the Process Outcome-Specific Measure at all time-points. Linear mixed-effects regression was used to identify associations between physical after-effects and distress over 12 months, adjusting for socio-demographic and clinical variables. MAIN OUTCOME MEASURES Prevalence of post-colposcopy physical after-effects. Associations between the presence of any physical after-effects, awareness of after-effects, and number of after-effects and distress. RESULTS Five-hundred and eighty-four women were recruited (response rate = 73, 59 and 52% at 4, 8 and 12 months, respectively). Eighty-two percent of women reported one or more physical after-effect(s). Multiple physical after-effects were common (two after-effects = 25%; three after-effects = 25%). Psychological distress scores declined significantly over time. In adjusted analyses, women who experienced all three physical after-effects had on average a 4.58 (95% CI: 1.10-8.05) higher distress scored than those who experienced no after-effects. Women who were unaware of the possibility of experiencing after-effects scored significantly higher for distress during follow-up. CONCLUSIONS The prevalence of physical after-effects of colposcopy and related procedures is high. The novel findings of inter-relationships between awareness of the possibility of after-effects and experiencing multiple after-effects, and post-colposcopy distress may be relevant to the development of interventions to alleviate post-colposcopy distress. TWEETABLE ABSTRACT Experiencing multiple physical after-effects of colposcopy is associated with psychological distress.
Collapse
Affiliation(s)
- M O'Connor
- National Cancer Registry Ireland, Cork, Ireland
| | - K O'Brien
- National Cancer Registry Ireland, Cork, Ireland
| | - J Waller
- Department of Behavioural Science and Health, University College London, London, UK
| | - P Gallagher
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - T D'Arcy
- Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - G Flannelly
- National Maternity Hospital, Dublin 2, Ireland
| | - C M Martin
- Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - J McRae
- National Cancer Registry Ireland, Cork, Ireland
| | - W Prendiville
- Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - C Ruttle
- Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - C White
- Trinity College Dublin, Dublin 2, Ireland
| | - L Pilkington
- Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - J J O'Leary
- Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - L Sharp
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
8
|
Taghavi K, Morell S, Lamb J, MacNab H, Innes C, Coffey K, Williman J, Simcock B, Sykes P. Initial observation of CIN2 does not appear to reduce quality of life in women under 25 years of age. Aust N Z J Obstet Gynaecol 2017; 57:473-478. [PMID: 28508566 DOI: 10.1111/ajo.12633] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/16/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although the patient perspective is implicit in the practice of medicine, research evaluating this remains scarce. In a climate where clinicians and policy-makers constantly strive to achieve more patient-centred models of care, this omission warrants attention. AIM To assess health-related quality of life (HrQoL) in women under 25 years of age with cervical intra-epithelial neoplasia grade 2 (CIN2) receiving conservative management (colposcopy follow-up, with treatment if necessary) compared with those receiving immediate excisional treatment with large loop excision of the transformation zone (LLETZ). METHODS An observational study evaluating HrQoL was conducted at Christchurch Women's Hospital, New Zealand. Women undergoing conservative management for CIN2 were compared with those undergoing immediate excisional treatment in an age-matched sample. The Short Form Health Survey 12 version 2 (SF-12v2) was used to evaluate HrQoL. Secondary outcomes of anxiety and sexual function were also assessed. RESULTS One hundred and four women with CIN2 participated in the study. Of these, 63 (60%) received conservative management and 41 (40%) received immediate excisional treatment with LLETZ. We found no significant difference in HrQoL between the groups in a multivariate regression analysis adjusted for parity, smoking and socioeconomic status. There were also no significant differences in sexual function or anxiety. CONCLUSION We found no difference in HrQoL by management strategy. Conservative management of CIN2 in women under 25 is unlikely to have an adverse impact on self-reported HrQoL, anxiety or sexual functioning compared with conventional management.
Collapse
Affiliation(s)
- Katayoun Taghavi
- Department of Obstetrics and Gynecology, Christchurch Women's Hospital, Christchurch, New Zealand
| | - Sára Morell
- Department of Obstetrics and Gynecology, University of Otago, Christchurch, New Zealand
| | - Jillian Lamb
- Department of Obstetrics and Gynecology, Christchurch Women's Hospital, Christchurch, New Zealand
| | - Helene MacNab
- Department of Obstetrics and Gynecology, Christchurch Women's Hospital, Christchurch, New Zealand
| | - Carrie Innes
- Department of Obstetrics and Gynecology, University of Otago, Christchurch, New Zealand
| | - Kate Coffey
- Department of Obstetrics and Gynecology, Dunedin Public Hospital, Dunedin, New Zealand
| | - Jonathan Williman
- Department of Population Health, University of Otago, Christchurch, New Zealand
| | - Bryony Simcock
- Department of Obstetrics and Gynecology, Dunedin Public Hospital, Dunedin, New Zealand
| | - Peter Sykes
- Department of Obstetrics and Gynecology, Christchurch Women's Hospital, Christchurch, New Zealand
| |
Collapse
|
9
|
O'Connor M, O'Leary E, Waller J, Gallagher P, D'arcy T, Flannelly G, Martin CM, McRae J, Prendiville W, Ruttle C, White C, Pilkington L, O'Leary JJ, Sharp L. Trends in, and predictors of, anxiety and specific worries following colposcopy: a 12-month longitudinal study. Psychooncology 2016; 25:597-604. [PMID: 26392040 DOI: 10.1002/pon.3980] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/18/2015] [Accepted: 08/19/2015] [Indexed: 02/11/2024]
Abstract
OBJECTIVE Little is known about which women are at greatest risk of adverse psychological after-effects following colposcopy. This study examined time trends in, and identified predictors of, anxiety and specific worries over 12 months. METHODS Women attending two hospital-based colposcopy clinics for abnormal cervical cytology were invited to complete psychosocial questionnaires at 4, 8 and 12 months following colposcopy. General anxiety and screening-specific worries (about cervical cancer, having sex and future fertility) were measured. Generalised estimating equations were used to assess associations between socio-demographic, lifestyle and clinical variables and risk of psychological outcomes. RESULTS Of 584 women initially recruited, 429, 343 and 303 completed questionnaires at 4, 8 and 12 months, respectively. Screening-specific worries declined significantly over time but were still relatively high at 12 months: 23%, 39% and 18% for worries about cervical cancer, fertility and having sex, respectively. Anxiety remained stable (20%) over time. Risks of cervical cancer worry and anxiety were both almost double in women without private health insurance (cervical cancer worry: OR = 1.80, 95% CI 1.25-2.61; anxiety: OR = 1.84, 95% CI 1.20-2.84). Younger women (<40 years) had higher risk of fertility worries. Non-Irish women had higher risk of anxiety (OR = 2.13, 95% CI 1.13-4.01). CONCLUSIONS Screening-specific worries declined over time but anxiety remained stable. Notable proportions of women still reported adverse outcomes 12 months following colposcopy, with predictors varying between outcomes. Women in socio-demographically vulnerable groups were at greatest risk of adverse psychological outcomes. This information could inform development of interventions to alleviate psychological distress post-colposcopy.
Collapse
Affiliation(s)
| | - Eamonn O'Leary
- National Cancer Registry Ireland, Kinsale Road, Cork, Ireland
| | - Jo Waller
- Health Behaviour Research Centre, University College London, London, UK
| | - Pamela Gallagher
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Tom D'arcy
- Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | | | - Cara M Martin
- Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - Judith McRae
- National Cancer Registry Ireland, Kinsale Road, Cork, Ireland
| | | | - Carmel Ruttle
- Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | | | | | - John J O'Leary
- Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - Linda Sharp
- Institute of Health and Society, Newcastle University, UK
| |
Collapse
|
10
|
Lorenzi AT, Fregnani JHT, Possati-Resende JC, Antoniazzi M, Scapulatempo-Neto C, Syrjänen S, Villa LL, Longatto-Filho A. Can the careHPV test performed in mobile units replace cytology for screening in rural and remote areas? Cancer Cytopathol 2016; 124:581-8. [DOI: 10.1002/cncy.21718] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 03/03/2016] [Accepted: 03/07/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Adriana T. Lorenzi
- Institute of Education and Research and Molecular Oncology Center, Barretos Cancer Hospital; Pio XII Foundation; Barretos São Paulo Brazil
| | - José Humberto T. Fregnani
- Institute of Education and Research and Molecular Oncology Center, Department of Researcher Support, Barretos Cancer Hospital; Pio XII Foundation; Barretos São Paulo Brazil
| | - Júlio César Possati-Resende
- Institute of Education and Research and Molecular Oncology Center, Department of Prevention, Barretos Cancer Hospital; Pio XII Foundation; Barretos São Paulo Brazil
| | - Márcio Antoniazzi
- Institute of Education and Research and Molecular Oncology Center, Department of Prevention, Barretos Cancer Hospital; Pio XII Foundation; Barretos São Paulo Brazil
| | - Cristovam Scapulatempo-Neto
- Institute of Education and Research and Molecular Oncology Center, Department of Pathology, Barretos Cancer Hospital; Pio XII Foundation; Barretos São Paulo Brazil
| | - Stina Syrjänen
- Medicity Research Laboratory and Department of Oral Pathology, Institute of Dentistry, Faculty of Medicine; University of Turku; Turku Finland
- Department of Pathology; Turku University Central Hospital; Turku Finland
| | - Luisa L. Villa
- Faculty of Medical Sciences of Santa Casa of São Paulo; São Paulo Brazil
- Department of Radiology and Oncology, Faculty of Medicine; Universidade de São Paulo; São Paulo Brazil
| | - Adhemar Longatto-Filho
- Institute of Education and Research and Molecular Oncology Center, Barretos Cancer Hospital; Pio XII Foundation; Barretos São Paulo Brazil
- Laboratory of Medical Investigation 14, Faculty of Medicine; Universidade de São Paulo; São Paulo Brazil
- Life and Health Sciences Research Institute, School of Health Sciences; University of Minho; Braga Portugal
- Life and Health Sciences Research Institute/3Bs-PT Government Associate Laboratory; Braga Portugal
| |
Collapse
|
11
|
Cook C, Brunton M. Pastoral power and gynaecological examinations: a Foucauldian critique of clinician accounts of patient-centred consent. SOCIOLOGY OF HEALTH & ILLNESS 2015; 37:545-560. [PMID: 25682852 DOI: 10.1111/1467-9566.12209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Invasive non-sedated clinical procedures such as gynaecological examinations are normalised; however, there is limited research highlighting the relational and technical skills required for clinicians to ensure patients' continued consent. A considerable body of research emphasises that women dislike examinations, leading to their non-compliance or a delayed follow up for gynaecological and sexual health problems. However, medical research focuses on 'problem' women; the role of clinicians receives limited appraisal. This article draws on interviews with sexual health clinicians in New Zealand, from metropolitan and provincial locations. The gynaecological care of women in New Zealand attained international notoriety with the 1988 publication of Judge Cartwright's inquiry into ethical shortcomings in cervical cancer research at the National Women's Hospital. Judge Cartwright's recommendations included patient-centred care in order to ensure informed consent had been received for clinical procedures and research participation. This article's critical analysis is that, although clinicians' language draws on humanistic notions of patient-centredness, Foucault's notion of secularised pastoral power enables a more nuanced appreciation of the ethical work undertaken by clinicians when carrying out speculum examinations. The analysis highlights both the web of power relations present during examination practices and the strategies clinicians use to negotiate women's continued consent; which is significant because consent is usually conceptualised as an event, rather than an unfolding, unstable process.
Collapse
Affiliation(s)
| | - Margaret Brunton
- School of Communication, Journalism and Marketing, Massey University, New Zealand
| |
Collapse
|
12
|
Frederiksen ME, Njor S, Lynge E, Rebolj M. Psychological effects of diagnosis and treatment of cervical intraepithelial neoplasia: a systematic review. Sex Transm Infect 2014; 91:248-56. [DOI: 10.1136/sextrans-2014-051754] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 11/30/2014] [Indexed: 11/04/2022] Open
|
13
|
Meevasana V, Suwannarurk K, Chanthasenanont A, Tanprasertkul C, Bhamarapravatana K, Pattaraarchachai J. Is the correlation between Papanicolaou smear and histopathology results affected by time to colposcopy? Asian Pac J Cancer Prev 2014; 15:1527-30. [PMID: 24641362 DOI: 10.7314/apjcp.2014.15.4.1527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Time to colposcopy (TC) after abnormal Pap smears was evaluated for influence on cytohistologic correlation (CHC). MATERIALS AND METHODS This retrospective study assessed the correlation between TC and CHC of women who had abnormal Pap smears. Colposcopic chart review included participants from 2010- 2013 who attended a colposcopic clinic, Thammasat University Hospital, Thailand. RESULTS Four hundred and sixty cases who had abnormal Pap smears were recruited. Pap reports were atypical smears with low grade squamous intraepithelial lesion (SIL), high grade SIL and cancer at 339, 114 and 7 cases, respectively. One hundred and twenty four patients underwent loop electrosurgical excision procedure (LEEP). A half of the cases were colposcopically examined within 1-2 months after abnormal Pap collection. CHC was 88 percent and not affected at all by TC. Subjects who attended cervical cancer screening from affiliated health providers had shorter TC than those screened in our tertiary hospital. CONCLUSIONS Time to colposcopy with abnormal Pap smears conducted at Thammasat University Hospital had a highest frequency of 42 days, in line with the literature. Length of TC does not affect the correlation between Pap and histopathologic reports. A longer waiting period for colposcopy did not alter progression or regression of the disease.
Collapse
Affiliation(s)
- Vorachart Meevasana
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Thammasat University, Rangsit Campus, Pathum Thani, Thailand E-mail :
| | | | | | | | | | | |
Collapse
|
14
|
Korfage IJ, Essink-Bot ML, Westenberg SM, Helmerhorst T, Habbema JDF, van Ballegooijen M. How distressing is referral to colposcopy in cervical cancer screening?: a prospective quality of life study. Gynecol Oncol 2013; 132:142-8. [PMID: 24219984 DOI: 10.1016/j.ygyno.2013.11.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 10/24/2013] [Accepted: 11/03/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Referral for colposcopy because of abnormal Pap test results is likely to be distressing, but the extent and duration of these effects are unknown. We aimed to fill this gap. METHODS We conducted a prospective observational study at two departments of Obstetrics and Gynecology (an academic and a non-academic setting). Women referred for colposcopy completed questionnaires before colposcopy, and at 1, 3, and 6 months afterwards. A reference group of 706 screen participants, aged 29-60 years old, was included and completed questionnaires once. Main outcome measures were generic health-related quality of life (HRQoL), assessed through the EQ-5D and the SF-12 physical and mental scores (PCS-12 and MCS-12); anxiety as assessed by STAI-6, and screen-specific anxiety as assessed by the psychological consequences questionnaire (PCQ). RESULTS 154 women responded to the questionnaire, of whom 132 were included in the analyses. Histological results were CIN 1 in 17/115 women (15%) and CIN 2+ in 62 (54%). In 36 women (31%) there was no histologically confirmed neoplasia. Before colposcopy physical HRQoL scores were similar or slightly better than in the reference group, while mental HRQoL (MSC-12) and (screen-specific) anxiety were worse (p<0.001). Irrespective of CIN-grades, anxiety washed out during follow-up (p<0.001), with changes being clinically relevant. CONCLUSIONS Referral for gynecological evaluation because of abnormal PAP-test results was distressing. Anxiety--and not the physical burden of management--seemed to be the most bothersome to women. For all CIN-grades, distress disappeared over six months following colposcopy, suggesting a reassuring effect of gynecological management.
Collapse
Affiliation(s)
- Ida J Korfage
- Dept. of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - Marie-Louise Essink-Bot
- Dept. of Public Health, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands
| | - Steven M Westenberg
- Dept. of Obstetrics and Gynecology, Medical Center Alkmaar, P.O. Box 501, 1800 AM Alkmaar, the Netherlands
| | - Theo Helmerhorst
- Dept. of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - J Dik F Habbema
- Dept. of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Marjolein van Ballegooijen
- Dept. of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| |
Collapse
|
15
|
Giannella L, Mfuta K, Lamantea R, Boselli F, Torrini B, Prandi S. Loop electrosurgical excision procedure as a life event that impacts on postmenopausal women. J Obstet Gynaecol Res 2012; 39:842-8. [DOI: 10.1111/j.1447-0756.2012.02061.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 09/17/2012] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - Fausto Boselli
- Mother-Infant Department; Institute of Obstetrics and Gynecology; University of Modena and Reggio Emilia; Modena; Italy
| | - Barbara Torrini
- Cervical Cancer Screening Centre; IRCCS-Arcispedale Santa Maria Nuova; Reggio Emilia; Italy
| | - Sonia Prandi
- Cervical Cancer Screening Centre; IRCCS-Arcispedale Santa Maria Nuova; Reggio Emilia; Italy
| |
Collapse
|
16
|
Kocabaş P, Khorshid L. A comparison of the effects of a special gynaecological garment and music in reducing the anxiety related to gynaecological examination. J Clin Nurs 2011; 21:791-9. [DOI: 10.1111/j.1365-2702.2011.03958.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
17
|
Sharp L, Cotton S, Carsin AE, Gray N, Thornton A, Cruickshank M, Little J. Factors associated with psychological distress following colposcopy among women with low-grade abnormal cervical cytology: a prospective study within the Trial Of Management of Borderline and Other Low-grade Abnormal smears (TOMBOLA). Psychooncology 2011; 22:368-80. [PMID: 22162138 DOI: 10.1002/pon.2097] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Revised: 08/11/2011] [Accepted: 10/10/2011] [Indexed: 11/12/2022]
Abstract
BACKGROUND Little is known about psychological after-effects of colposcopy and associated investigations and treatment in women with low-grade abnormal cervical cytology. We investigated psychological distress following colposcopy and related procedures. METHODS Nine hundred and eighty-nine women aged 20-59 years with routine cytology showing low-grade abnormalities were recruited to the Trial of Management of Borderline and other Low-grade Abnormal smears and attended colposcopy. If the cervical transformation zone (TZ) was colposcopically abnormal, women had immediate loop excision or diagnostic punch biopsies, with treatment if these showed cervical intraepithelial neoplasia grade 2/3 (CIN2/3). Women completed socio-demographic and psychosocial questionnaires at recruitment and before colposcopy. Six weeks after their last procedure, women completed the Impact of Event Scale (IES). Logistic regression was used to determine factors associated with significant psychological distress (IES ≥ 9). Analyses were stratified by colposcopic impression. RESULTS The response rate was 74%. Six weeks after the last procedure, 86 (21%) of 391 women with a normal TZ had significant distress compared with 144 (42%) of 337 with an abnormal TZ. In both groups, significant distress was associated with anxiety pre-colposcopy and pain or discharge afterwards. Additional variables predicting distress in women with a normal TZ were worries about having sex and dissatisfaction with support from others. In women with an abnormal TZ, additional predictors of distress were younger age, CIN2/3, bleeding following colposcopy and worries about having cancer. CONCLUSIONS Substantial proportions of women experience psychological distress after colposcopy and related procedures, even when the colposcopy is normal. This is an important cost of cervical screening. Interventions to alleviate these adverse psychological effects are required.
Collapse
Affiliation(s)
- Linda Sharp
- National Cancer Registry Ireland, Cork Airport Business Park, Kinsale Road, Cork, Ireland.
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Cook C. 'About as comfortable as a stranger putting their finger up your nose': speculation about the (extra)ordinary in gynaecological examinations. CULTURE, HEALTH & SEXUALITY 2011; 13:767-780. [PMID: 21656407 DOI: 10.1080/13691058.2011.577906] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In public health education, gynaecological examinations are presented as a routine and ordinary procedure. Medical research addressing women's reasons for screening reluctance emphasises underlying psychological categories of 'anxiety' and 'poor coping'. Minimal attention is paid to the effects of clinicians' interventions upon women's decision-making. Normalising promotes women's participation as speculum examinations are an essential part of many contemporary diagnostic and treatment procedures. In-depth email interviews were conducted with 26 women with diagnosis of either of the two commonest viral sexually transmitted infections, human papilloma virus and herpes simplex virus, and 12 sexual health clinicians. Data were analysed thematically. Findings indicate that women's screening compliance is influenced by clinicians' (in)attention to power relations, rapport-building, attentiveness to bodily (dis)comfort, technical skill and gender. Women's feedback is a valuable resource in devising interventions that may promote participation in examinations.
Collapse
Affiliation(s)
- Catherine Cook
- School of Health and Social Services, Massey University, Auckland, New Zealand.
| |
Collapse
|
19
|
Hendriksen MTJ, VAN Delft KWM, Bremer GLH, Mertens HJMM. Patient satisfaction in treatment for cervical pathology. Oncol Lett 2011; 2:439-443. [PMID: 22866101 DOI: 10.3892/ol.2011.273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 03/08/2011] [Indexed: 11/06/2022] Open
Abstract
This study aimed to analyse the satisfaction levels of patients treated for cervical dysplasia. At the Orbis Medical Center, all cases of abnormal cervical cytology are referred for colposcopy; however, there are three possible routings for patients: i) Patients are informed by the gynecologist about the colposcopy in a visit to the outpatient clinic, and colposcopy is planned in a second visit; ii) patients are informed by the gynecologist immediately before the colposcopy (a single visit); or iii) patients are called by a nurse practitioner 1-2 weeks prior to the colposcopy. The nurse practitioner informs patients about their Pap smear result, the colposcopy procedure and the follow-up (single visit plus telephone conversation). Patient satisfaction was analysed in the diagnostic and occasionally in the therapeutic colposcopies, with regards to information, treatment, appeasement and number of visits. The issue of whether the introduction of nurse practitioners improved patient satisfaction was also assessed. Patient satisfaction questionnaires were sent to all 593 patients who underwent a colposcopic examination for the first time following an abnormal smear test result. Data were analysed using SPSS 14.0. For statistical analyses, χ(2) tests and the Mann-Whitney U test were used. P<0.05 was considered to be statistically significant. The response rates did not differ significantly among the three groups of patients. In general, patient satisfaction regarding care was high (96%). The role of the nurse practitioner was rated highly (8.0-8.4). Although there were differences in the number of visits and satisfaction regarding the information provided, patient satisfaction did not differ significantly between groups 1 and 3. Patients in group 2 were significantly less satisfied with regard to almost all analysed data. In conclusion, the single visit procedure is extremely efficient. Patient satisfaction did not differ significantly between groups 1 and 3, but group 2 patients were significantly less satisfied. The introduction of nurse practitioners improves patients' knowledge, comfort and satisfaction. Furthermore, it reduces the number of visits required. Efficient treatment strategies were introduced and patient satisfaction was increased.
Collapse
Affiliation(s)
- M T J Hendriksen
- Gynecology Department, Orbis Medical Center, Sittard-Geleen, The Netherlands
| | | | | | | |
Collapse
|
20
|
Long-term psychosocial impact of alternative management policies in women with low-grade abnormal cervical cytology referred for colposcopy: a randomised controlled trial. Br J Cancer 2010; 104:255-64. [PMID: 21179033 PMCID: PMC3031895 DOI: 10.1038/sj.bjc.6606042] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The debate continues regarding the best management for women with low-grade abnormal cervical cytology attending colposcopy. We compared psychosocial outcomes of alternative management policies in these women. METHODS In all, 989 women, aged 20-59 years, with low-grade abnormal cytology, were randomised to immediate large loop excision (LLETZ) or two to four targeted punch biopsies taken immediately with recall for LLETZ if these showed cervical intra-epithelial neoplasia 2/3. At 6 weeks after the last procedure, women completed the hospital anxiety and depression scale (HADS) and the impact of event scale (IES). At 12, 18, 24 and 30 months post recruitment, women completed the HADS and process outcome specific measure (POSM). Prevalence of significant depression (≥ 8), significant anxiety (≥ 11) and distress (≥ 9) and median POSM scores were compared between arms. Multivariate odds ratios (ORs) for immediate LLETZ vs biopsy and recall were computed. RESULTS Over the entire follow-up, there was no significant difference between arms in cumulative prevalence or risk of significant depression (OR=0.78, 95% CI 0.52-1.17) or significant anxiety (OR=0.83, 95% CI 0.57-1.19). At 6 weeks post procedure, distress did not differ significantly between arms. At later time points, 8-11% had significant depression and 14-16% had significant anxiety but with no differences between arms. The POSM scores did not differ between the arms. CONCLUSIONS There is no difference in long- or short-term psychosocial outcomes of immediate LLETZ and punch biopsies with selective recall.
Collapse
|
21
|
Pather S, Tai D, Philp S, Nattress K, Carter J, Dalrymple C, Atkinson K. A prospective study assessing patient satisfaction at a large tertiary gynecologic oncology/dysplasia unit. PATIENT-RELATED OUTCOME MEASURES 2010; 1:149-52. [PMID: 22915960 PMCID: PMC3417914 DOI: 10.2147/prom.s13624] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patient satisfaction is an important quality assurance measure in the delivery of health care. We conducted a prospective study to assess patient satisfaction at a large tertiary oncology/dysplasia unit. AIMS To assess current patient satisfaction at a large tertiary oncology/dysplasia unit and identify potential areas for improvement. METHODS This was a prospective study of patients attending a tertiary oncology/dysplasia unit. Patients were invited to participate and, if they agreed, were given a validated questionnaire to complete at the end of their consultation. Descriptive statistics were then used to analyze the data and identify potential areas of improvement. RESULTS One hundred eighty-seven patients were recruited, and 96% of patients were satisfied with the overall level of care received. Significant positive features of the service included helpfulness of the staff, cleanliness of the facility, and measures implemented to respect patient privacy. Lack of patient parking, waiting times in the clinic, difficulties in contacting the service, and locating the building were identified as areas for improvement. CONCLUSION Patients attending our facility were largely satisfied with the overall level of care received. Nonclinical factors including parking, waiting times, and access to the service were identified as areas for improvement.
Collapse
Affiliation(s)
- Selvan Pather
- The Sydney Gynaecologic Oncology Group, Sydney Cancer Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | | | | | | | | | | | | |
Collapse
|
22
|
Patients’ psychological reactions to colposcopy and LLETZ treatment for cervical intraepithelial neoplasia. Eur J Obstet Gynecol Reprod Biol 2009; 146:96-9. [DOI: 10.1016/j.ejogrb.2009.05.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Revised: 03/30/2009] [Accepted: 05/02/2009] [Indexed: 11/24/2022]
|