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
|
Ilic I, Babic G, Dimitrijevic A, Sipetic Grujicic S, Ilic M. Predictors of depressive symptoms before and after diagnostic procedures in women with abnormal Pap smear attending cervical cancer screening programme in Serbia. Eur J Cancer Care (Engl) 2022; 31:e13634. [PMID: 35697508 DOI: 10.1111/ecc.13634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 04/07/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Receipt of a positive Papanicolaou screening result and subsequent referral for diagnostic tests can cause psychological stress. Still, not enough is known about depression before and after the diagnostic test in these women. The aim of this study was to determine the burden and predictors of depressive symptoms prior to and after diagnostic investigations in women who had received a positive Papanicolaou screening result. METHODS This was a cross-sectional study. Study cohort comprised women who received an abnormal Papanicolaou screening result. Women completed the socio-demographic questionnaire and 'The Center for Epidemiologic Studies Depression, CES-D' questionnaire before and after diagnostic tests (colposcopy/biopsy/endocervical curettage) to assess factors related to depression. RESULTS No significant difference was noted in the frequency of depressive symptoms (CES-D score ≥ 16) before and after diagnostic investigations, but the mean score on CES-D scale showed a significant difference before and after diagnostic investigations (13.98 ± 9.56 and 12.74 ± 9.15, respectively). A significant predictor of depression before diagnostic investigations was spontaneous abortion, whereas family history of other gynaecological cancers was a predictor of depression after diagnostic investigations. CONCLUSIONS Our findings could contribute to improving the rates of cervical cancer screening, by identifying women at risk for depression before and after investigations.
Collapse
Affiliation(s)
- Irena Ilic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Goran Babic
- Department of Gynaecology and Obstetrics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Aleksandra Dimitrijevic
- Department of Gynaecology 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
|
3
|
Ilic I, Babic G, Dimitrijevic A, Grujicic SS, Ilic MD. Depression before and after diagnostic procedures among women with abnormal finding of Papanicolaou screening test. Cancer Med 2022; 11:3518-3528. [PMID: 35322940 PMCID: PMC9487877 DOI: 10.1002/cam4.4709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/16/2022] [Accepted: 03/13/2022] [Indexed: 11/08/2022] Open
Abstract
Background Some studies did find significant differences in the level of depression of women while undergoing diagnostic evaluation of an abnormal Papanicolaou screening smear, but findings were not consistent. This study aimed to assess prevalence and correlates of depression in women with abnormal cervical screening results before and after diagnostic procedures. Methods A cross‐sectional study was carried out during 2017 in a cohort of women with positive Papanicolaou screening test before and after diagnostic procedures (colposcopy/biopsy/endocervical curettage) at the university Clinical Centre Kragujevac, Serbia. Women completed a questionnaire about demographics, lifestyle, and other factors of interest. Also, questionnaire “Hospital Anxiety and Depression Scale” (HADS) was used immediately before and 2–4 weeks after the diagnostic procedures: a score of ≥8 on HADS‐D and HADS‐A subscales indicated depression and anxiety, respectively. Multivariate logistic regression was applied in the data analysis. Results The study comprised 172 women, giving a response rate of 72.3%. The mean age of the participants was 47.8 ± 11.1 years (range 23–65). The frequency of depressive symptoms was significantly higher after diagnostic procedures (48.3%) than before diagnostic procedures (37.2%) (p = 0.038). Before diagnostic procedures, older age (OR = 1.60; 95% CI = 1.09–2.34; p = 0.017), and level of anxiety according to the HADS‐A subscale (OR = 1.61; 95% CI = 1.38–1.88; p < 0.001) were significant independent predictors of depression. After diagnostic procedures, significant independent predictors of depression were urban place of residence (OR = 0.12; 95% CI = 0.03–0.47; p = 0.002) and level of anxiety according to the HADS‐A subscale (OR = 1.85; 95% CI = 1.54–2.21; p < 0.001). Conclusion Our study showed that older age, rural residence, and anxiety play a role in shaping the risk of depression among women undergoing additional diagnostic procedures after receiving an abnormal Papanicolaou screening result.
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 D Ilic
- Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| |
Collapse
|
4
|
Managing the Consequences of Oncological Major Surgery: A Short- and Medium-Term Skills Assessment Proposal for Patient and Caregiver through M.A.D.I.T. Methodology. Behav Sci (Basel) 2022; 12:bs12030077. [PMID: 35323396 PMCID: PMC8945744 DOI: 10.3390/bs12030077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 02/06/2023] Open
Abstract
The effects of cancer surgery and treatment harm patients’ life and working ability: major causes of this can be intensified by the postoperative symptoms. This study, the first part of the HEAGIS project (Health and Employment after Gastrointestinal Surgery), proposes a method to assess patients and caregivers’ competences in dealing with postoperative course and the related needs to improve the adequate competences. In this observational study, an ad hoc structured interview was conducted with 47 patients and 15 caregivers between the third and fifteenth postoperative day. Oesophageal (38%), esophagogastric junction (13%), gastric (30%), colon (8%) and rectum (11%) cancer patients were considered. Computerized textual data analysis methodology was used to identify levels of competences. Text analysis highlighted three different levels (low, medium and high) of four specific types of patients and caregivers’ competences. In particular, the overall trend of the preview of future scenarios and use of resource competences was low. Less critical were situation evaluation and preview repercussion of own actions’ competences. Caregivers’ trends were similar. The Kruskal–Wallis test did not distinguish any differences in the level of competences related to the characteristics of the participants. Patients and caregivers are not accurate in planning the future after surgery, using personal beliefs rather than referring to physicians, and not recognizing adequate resources. The medium-low competences’ trend leads to unexpected critical situations, and patients could not deal with them in a maximally effective way. Both patients and caregivers should be taken over by healthcare professionals to improve patients’ competences and make the curative surgery effective in daily life.
Collapse
|
5
|
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
|
6
|
White C, Bakhiet S, Bates M, Keegan H, Pilkington L, Ruttle C, Sharp L, O' Toole S, Fitzpatrick M, Flannelly G, O' Leary JJ, Martin CM. Triage of LSIL/ASC-US with p16/Ki-67 dual staining and human papillomavirus testing: a 2-year prospective study. Cytopathology 2016; 27:269-76. [PMID: 26932360 DOI: 10.1111/cyt.12317] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate human papillomavirus (HPV) DNA testing and p16/Ki-67 staining for detecting cervical intraepithelial grade 2 or worse (CIN2+) and CIN3 in women referred to colposcopy with minor abnormal cervical cytology low-grade squamous intraepithelial lesions (LSIL) and atypical squamous cells of undermined significance (ASC-US). The clinical performance of both tests was evaluated as stand-alone tests and combined, for detection CIN2+ and CIN3 over 2 years. METHODS ThinPrep(®) liquid-based cytology (LBC) specimens were collected from 1349 women with repeat LSIL or ASC-US. HPV DNA was performed using Hybrid Capture. Where adequate material remained (n = 471), p16/Ki-67 overexpression was assessed. Clinical performance for detection of histologically diagnosed CIN2+ and CIN3 was calculated. RESULTS Approximately 62.2% of the population were positive for HPV DNA, and 30.4% were positive for p16/Ki-67. p16/Ki-67 showed no significant difference in positivity between LSIL and ASC-US referrals (34.3% versus 28.6%; P = 0.189). Women under 30 years had a higher rate of p16/Ki-67 compared to those over 30 years (36.0% versus 26.6%; P = 0.029). Overall HPV DNA testing produced a high sensitivity for detection of CIN3 of 95.8% compared to 79.2% for p16/Ki-67. In contrast, p16/Ki-67 expression offered a higher specificity, 75.2% versus 40.4% for detection of CIN3. Combining p16/Ki-67 with HPV DNA improved the accuracy in distinguishing between CIN3 and <CIN3. The absolute risk of CIN3 increased from 15.6% in women who were HPV DNA positive to 27% in women positive for HPV DNA and p16/Ki-67. Those negative for HPV DNA and p16/Ki-67 had a low risk of 1.2% of CIN3. CONCLUSION The addition of p16/Ki-67 to HPV DNA testing leads to a more accurate stratification of CIN in women presenting with minor cytological abnormalities.
Collapse
Affiliation(s)
- C White
- Department of Histopathology, Trinity College Dublin, Dublin, Ireland.,Department of Pathology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - S Bakhiet
- Department of Pathology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - M Bates
- Department of Histopathology, Trinity College Dublin, Dublin, Ireland.,Department of Pathology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - H Keegan
- Department of Histopathology, Trinity College Dublin, Dublin, Ireland.,Department of Pathology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - L Pilkington
- Department of Pathology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - C Ruttle
- Department of Pathology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - L Sharp
- National Cancer Registry Ireland, Cork, Ireland
| | - S O' Toole
- Department of Pathology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - M Fitzpatrick
- Department of Obstetrics and Gynaecology, National Maternity Hospital, Dublin, Ireland
| | - G Flannelly
- Department of Obstetrics and Gynaecology, National Maternity Hospital, Dublin, Ireland
| | - J J O' Leary
- Department of Histopathology, Trinity College Dublin, Dublin, Ireland.,Department of Pathology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - C M Martin
- Department of Histopathology, Trinity College Dublin, Dublin, Ireland.,Department of Pathology, Coombe Women and Infants University Hospital, Dublin, Ireland
| |
Collapse
|
7
|
O'Connor M, Gallagher P, Waller J, Martin CM, O'Leary JJ, Sharp L. Adverse psychological outcomes following colposcopy and related procedures: a systematic review. BJOG 2016; 123:24-38. [PMID: 26099164 DOI: 10.1111/1471-0528.13462] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although colposcopy is the leading follow-up option for women with abnormal cervical cytology, little is known about its psychological consequences. OBJECTIVES We performed a systematic review to examine: (1) what, if any, are the adverse psychological outcomes following colposcopy and related procedures; (2) what are the predictors of adverse psychological outcomes post-colposcopy; and (3) what happens to these outcomes over time. SEARCH STRATEGY Five electronic databases (PubMed, PsychINFO, CINAHL, Web of Science, Scopus) were searched for studies published in English between January 1986 and February 2014. SELECTION CRITERIA Eligible studies assessed psychological wellbeing at one or more time-points post-colposcopy. DATA COLLECTION AND ANALYSIS Two reviewers independently screened titles and abstracts. Full texts of potentially eligible papers were reviewed. Data were abstracted from, and a quality appraisal performed of, eligible papers. MAIN RESULTS Twenty-three papers reporting 16 studies were eligible. Colposcopy and related procedures can lead to adverse psychological outcomes, particularly anxiety. Ten studies investigated predictors of adverse psychological outcomes; management type and treatment had no impact on this. Seven studies investigated temporal trends in psychological outcomes post-colposcopy; findings were mixed, especially in relation to anxiety and distress. Studies were methodologically heterogeneous. CONCLUSIONS Follow-up investigations and procedures for abnormal cervical cytology can cause adverse psychological outcomes among women. However, little is known about the predictors of these outcomes or how long they persist. There is a need for a more standardised approach to the examination of the psychological impact of colposcopy, especially longer-term outcomes. TWEETABLE ABSTRACT Follow-up investigations for abnormal cervical cytology can cause adverse psychological outcome among women.
Collapse
Affiliation(s)
- M O'Connor
- National Cancer Registry Ireland, Cork, Ireland
| | - P Gallagher
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - J Waller
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, London, UK
| | - C M Martin
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - J J O'Leary
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - L Sharp
- Institute of Health &/ Society, Newcastle University, Newcastle, UK
| |
Collapse
|
8
|
Sharp L, Cotton S, Cruickshank M, Gray N, Smart L, Whynes D, Little J. Impact of post-colposcopy management on women's long-term worries: results from the UK population-based TOMBOLA trial. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2015; 42:43-51. [DOI: 10.1136/jfprhc-2015-101170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 08/12/2015] [Indexed: 11/04/2022]
|
9
|
Sharp L, Cotton SC, Cruickshank ME, Gray NM, Neal K, Rothnie K, Thornton AJ, Walker LG, Little J, Cruickshank M, Murray G, Parkin D, Smart L, Walker E, Waugh N, Avis M, Chilvers C, Fielding K, Hammond R, Jenkins D, Johnson J, Neal K, Seth R, Whynes D, Duncan I, Robertson A, Little J, Sharp L, Russell I, Walker L, Anthony B, Bell S, Bowie A, Brown K, Brown J, Chew K, Cochran C, Cotton S, Dean J, Dunn K, Edwards J, Evans D, Fenty J, Finlayson A, Gallagher M, Gray N, Heddle M, Innes A, Jobson D, Keillor M, MacGregor J, Mackenzie S, Mackie A, McPherson G, Okorocha I, Reilly M, Rodgers J, Thornton A, Yeats R, Alexander L, Buchanan L, Henderson S, Iterbeke T, Lucas S, Manderson G, Nicol S, Reid G, Robinson C, Sandilands T, Adrian M, Al-Sahab A, Bentley E, Brook H, Bushby C, Cannon R, Cooper B, Dowell R, Dunderdale M, Gabrawi, Guo L, Heideman L, Jones S, Lawson S, Philips Z, Platt C, Prabhakaran S, Rippin J, Thompson R, Williams E, Woolley C, Cotton S, Harrild K, Norrie J, Sharp L, Day N, Marteau T, Parmar M, Patnick J, Woodman C, Altman D, Moss S, Wells M. Long-Term Worries after Colposcopy: Which Women Are at Increased Risk? Womens Health Issues 2015; 25:517-27. [DOI: 10.1016/j.whi.2015.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 03/19/2015] [Accepted: 04/06/2015] [Indexed: 10/23/2022]
|
10
|
O'Connor M, Waller J, Gallagher P, Martin CM, O'Leary JJ, D'Arcy T, Prendiville W, Flannelly G, Sharp L. Understanding Women's Differing Experiences of Distress after Colposcopy: A Qualitative Interview Study. Womens Health Issues 2015; 25:528-34. [PMID: 26189936 DOI: 10.1016/j.whi.2015.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/26/2015] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Women who have an abnormal cervical cytology test may be referred for a colposcopy. Accumulating evidence suggests some women may experience distress after colposcopy. This exploratory study examined women's differing experiences of post-colposcopy distress with the aim of identifying factors that are predictive of, or protective against, distress. METHODS We carried out semistructured, qualitative interviews with 23 women who had undergone colposcopies. Interviews were transcribed verbatim, coded, and analyzed thematically. The Framework Approach was used to summarize and organize the data and identify emerging higher order themes. RESULTS Two forms of post-colposcopy distress emerged: 1) short term and 2) long term. Short-term distress was experienced immediately after the colposcopy and in the days afterward, and was usually related to the physical experience of the colposcopy. Long-term distress typically persisted over time and was related to concerns about fertility, cervical cancer, and sexual intercourse. The drivers of short-term and long-term distress differed. Factors related to short-term distress were feeling unprepared for the procedure, having a negative experience of the procedure, and attending the clinic alone. Factors related to long-term distress were future intentions to have (more) children, having physical after-effects of the procedure that impacted on the woman's life, and being under on-going clinic surveillance. Absence of these factors (e.g., being accompanied to the clinic) was protective against short- and long-term distress. CONCLUSIONS Colposcopy can lead to short- and long-term post-procedural distress for some women. We identified a range of factors, some potentially modifiable, that seem to influence the chances of experiencing distress. These results may inform the development of strategies or interventions aimed at preventing or minimizing distress after colposcopy and related procedures.
Collapse
Affiliation(s)
- Mairead O'Connor
- Department of Research, National Cancer Registry Ireland, Cork Airport Business Park, Cork, Ireland.
| | - Jo Waller
- Health Behaviour Research Centre, University College London, London, UK
| | - Pamela Gallagher
- Department of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Cara M Martin
- Department of Pathology, Coombe Women and Infants University Hospital, Dolphin's Barn, Dublin, Ireland
| | - John J O'Leary
- Department of Pathology, Coombe Women and Infants University Hospital, Dolphin's Barn, Dublin, Ireland
| | - Tom D'Arcy
- Department of Obstetrics and Gynaecology, Coombe Women and Infants University Hospital, Dolphin's Barn, Dublin, Ireland
| | - Walter Prendiville
- Department of Obstetrics and Gynaecology, Coombe Women and Infants University Hospital, Dolphin's Barn, Dublin, Ireland
| | - Grainne Flannelly
- Department of Obstetrics and Gynaecology, National Maternity Hospital, Dublin, Ireland
| | - Linda Sharp
- Department of Research, National Cancer Registry Ireland, Cork Airport Business Park, Cork, Ireland
| |
Collapse
|
11
|
Cotton SC, Sharp L, Little J, Gray NM, Walker LG, Whynes DK, Cruickshank ME. A normal colposcopy examination fails to provide psychological reassurance for women who have had low-grade abnormal cervical cytology. Cytopathology 2014; 26:178-87. [DOI: 10.1111/cyt.12173] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2014] [Indexed: 10/24/2022]
Affiliation(s)
- S. C. Cotton
- Obstetrics & Gynaecology; University of Aberdeen; Foresterhill Aberdeen UK
| | - L. Sharp
- National Cancer Registry Ireland; Cork Ireland
| | - J. Little
- Department of Epidemiology and Community Medicine; University of Ottawa; Ottawa ON Canada
| | - N. M. Gray
- Centre of Academic Primary Care; University of Aberdeen; Foresterhill Aberdeen UK
| | | | - D. K. Whynes
- School of Economics; University of Nottingham; Nottingham UK
| | - M. E. Cruickshank
- Obstetrics & Gynaecology; University of Aberdeen; Foresterhill Aberdeen UK
| | | |
Collapse
|
12
|
Whynes DK, Sharp L, Cotton SC, Cruickshank M, Gray NM, Little J, Waugh N. Impact of alternative management policies on health-related quality of life in women with low-grade abnormal cervical cytology referred for colposcopy. Eur J Obstet Gynecol Reprod Biol 2013; 169:88-92. [PMID: 23481576 DOI: 10.1016/j.ejogrb.2013.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 01/15/2013] [Accepted: 02/03/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess the health-related quality of life (HRQoL) over 30 months among women who received colposcopy following low-grade abnormal cervical cytology. DESIGN 751 women with low-grade abnormal cytology were seen for colposcopy. Of these, 350 additionally underwent either immediate treatment by large loop excision of the transformation zone (LLETZ) or investigation by punch biopsy followed by treatment of high-grade cervical intraepithelial neoplasia if present. The HRQoL of the women was assessed on seven separate occasions over 30 months by means of the EQ-5D instrument. Outcomes for women receiving colposcopy only, colposcopy with biopsy and colposcopy with LLETZ were compared. RESULTS Women experienced modest short-term increases in HRQoL, statistically significant for the colposcopy only and biopsy groups but not for the LLETZ group. HRQoL in all three groups thereafter fell until 12 months following recruitment, significantly so for the LLETZ group. Changes in EQ-5D index score arose primarily from changes in severities in the "pain and discomfort" and "anxiety and depression" domains. Changes in the visual analogue scale (VAS) representations of quality of life corresponded closely to those of the index scores and most of the VAS scores themselves did not differ from VAS population norms. All inter-assessment changes in index scores were smaller than the minimum important difference for the instrument. Beyond 18 months from recruitment, HRQoL stabilised in all three groups. CONCLUSION Women referred to colposcopy following a low-grade abnormal smear test result experienced a short-term improvement in their health-related quality of life, but the long-term effect was insubstantial. HRQoL over the post-recruitment follow-up period did not vary by intervention.
Collapse
Affiliation(s)
- David K Whynes
- School of Economics, University of Nottingham, Nottingham, England, United Kingdom.
| | | | | | | | | | | | | |
Collapse
|
13
|
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
|
14
|
Johnson CY, Sharp L, Cotton SC, Harris CA, Gray NM, Little J. Human papillomavirus infection and anxiety: analyses in women with low-grade cervical cytological abnormalities unaware of their infection status. PLoS One 2011; 6:e21046. [PMID: 21698168 PMCID: PMC3116883 DOI: 10.1371/journal.pone.0021046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Accepted: 05/17/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Women testing positive for human papillomavirus (HPV) infection experience increased levels of anxiety that have been attributed to fears of stigmatization and developing cervical cancer. The objective of this study was to investigate the association between HPV infection and anxiety in women who were unaware they had been tested specifically for HPV, to determine if any anxiety experienced by HPV-positive women could be due to causes other than learning of test results. METHODS This study was nested within a randomised controlled trial of management of women with abnormal cervical cytology conducted in the United Kingdom with recruitment between 1999 and 2002. At baseline, prior to having a sample taken for HPV testing, the results of which were not disclosed, women were assessed for anxiety using the Hospital Anxiety and Depression Scale and asked about fears of developing cervical cancer ("cancer worries"); this assessment was repeated at 12, 18, 24, and 30 months of follow-up. Logistic regression and generalized estimating equations were used for the cross-sectional (baseline) and longitudinal analyses, respectively. RESULTS Among the 2842 participants, there was no association between HPV status and anxiety among white women. Among non-white women, however, anxiety was less common among HPV-positive than HPV-negative women (adjusted odds ratio 0.41, 95% confidence interval 0.22 to 0.77). Among non-smokers, cancer worry was more common in HPV-positive than HPV-negative women; the opposite association was observed among ex-smokers. CONCLUSIONS Associations between HPV status and anxiety may be explained by factors other than learning of test results and may vary by ethnicity and lifestyle factors.
Collapse
Affiliation(s)
- Candice Y Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
| | | | | | | | | | | |
Collapse
|