Do women comply with recommendations for Papanicolaou smears following colposcopy? A retrospective study

Understanding the role of oncogenic human papillomavirus (HPV) status on adherence behaviors among women with abnormal cervical cytology

BACKGROUND

With the introduction of oncogenic Human Papillomavirus (HPV) testing into cervical screening there is a renewed focus on primary prevention among high-risk groups. To date, little is known about the effectiveness of this program, and the extent to which individual-level factors, such as psychosocial health and agency, may play a role. In particular, it is unclear if knowledge of one's oncogenic HPV status impacts on adherence behaviors amongst women with screening abnormalities. The purpose of this study was to identify if clinical, demographic or psychosocial factors predict non-adherence with recommended colposcopy follow-up.

METHODS

This prospective pilot study included 145 women referred to a large Toronto colposcopy clinic between December, 2013 and September, 2014. Demographic, clinical and psychosocial characteristics were collected at three points in time: (1) at initial colposcopy consultation; (2) 4-6 weeks following initial consultation, and; (3) at time of follow-up appointment (within 12 months of initial consultation).

RESULTS

Overall, 13% (n = 145) of the women were classified as non-adherent. Older women (OR = 0.73, p < 0.01) and those with higher-grade lesions (OR = 0.10, p < 0.01) were less likely to be non-adherent, whereas current smokers (OR = 22.46, p < 0.01) were more likely to be non-adherent. While not statistically significant, variation in rates of non-adherence amongst the various HPV status groups (untested; 15.3%, HPV positive; 5.3%, HPV negative; 6.7%) warrants further study.

CONCLUSION

Findings of this study indicate that younger women, those with higher-grade lesions and current smokers were more likely to be non-adherent to recommended colposcopy follow-up. While HPV status did not reach statistical significance, the direction of this finding suggests that testing for HPV may have a positive reinforcing role on adherence to follow-up. The direction of this finding warrants further study, and potentially a practical clinical goal as HPV testing for women becomes standard of care.

HEALTH SURVEILLANCE AND PAP TEST COVERAGE: INTEGRATIVE REVIEW

ABSTRACT This integrative review aimed to evidence in the literature health surveillance activities that contribute to the increased coverage of the cervical Pap smear. The search was undertaken between April and May 2014 in the databases LILACS, CINAHL, MEDLINE and Scopus, using the keywords health surveillance, cervix neoplasm prevention, and Papanicolaou test, in Portuguese, English and Spanish. We selected 341 articles, of which 33 met the inclusion criteria. In studies, the actions have been identified and grouped according to two main control practices of cervical cancer adopted in Brazil: primary prevention and secondary prevention, with emphasis on health promotion and prevention actions that contributed to the increased coverage of the cervical Pap smear.

Effect of Patient Education on Postcolposcopy Follow-Up

The purpose of this study was to investigate the effects of patient education on human papillomavirus (HPV) infection and abnormal Pap smears for women scheduled for colposcopy and their compliance to treatment recommendations. A convenience sample of 60 women was included in the study. The experimental group included 30 women scheduled for colposcopy who received education prior to procedure. Thirty patients in the control group were women referred for colposcopy the year before the study. Both groups were similar in age, ethnicity, insurance status, and histological findings. Recall rates were analyzed between the two groups and results demonstrated a statistical difference in the return rate of the experimental group. Patient education increased compliance to treatment recommendations post colposcopy. Findings provide important information on the importance of educating patients with abnormal Pap results regarding HPV and sequelae of infection.

Patient predictors of colposcopy comprehension of consent among English- and Spanish-speaking women

PURPOSE

patients with limited English proficiency may be at increased risk for diminished understanding of clinical procedures. This study sought to assess patient predictors of comprehension of colposcopy information during informed consent and to assess differences in understanding between English and Spanish speakers.

METHODS

between June and August 2007, English- and Spanish-speaking colposcopy patients at two Boston hospitals were surveyed to assess their understanding of the purpose, risks, benefits, alternatives, and nature of colposcopy. Patient demographic information was collected.

FINDINGS

there were 183 women who consented to participate in the study. We obtained complete data on 111 English speakers and 38 Spanish speakers. English speakers were more likely to have a higher education, greater household income, and private insurance. Subjects correctly answered an average of 7.91 ± 2.16 (72%) of 11 colposcopy survey questions. English speakers answered more questions correctly than Spanish speakers (8.50 ± 1.92 [77%] vs 6.21 ± 1.93 [56%]; p < .001). Using linear regression to adjust for confounding variables, we found that language was not significantly associated with greater understanding (p = .46). Rather, education was the most significant predictor of colposcopy knowledge (p < .001).

CONCLUSION

many colposcopy patients did not understand the procedure well enough to give informed consent. The observed differences in colposcopy comprehension based on language were a proxy for differences in education. Education, not language, predicted subjects' understanding of colposcopy. These results demonstrate the need for greater attention to patients' educational background to ensure adequate understanding of clinical information.