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Ciavattini A, Delli Carpini G, Giannella L, Del Fabro A, Banerji V, Hall G, Barbero M, Sopracordevole F. An online survey on emotions, impact on everyday life, and educational needs of women with HPV positivity or abnormal Pap smear result. Medicine (Baltimore) 2021; 100:e27177. [PMID: 34766557 PMCID: PMC8589238 DOI: 10.1097/md.0000000000027177] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/20/2021] [Indexed: 01/05/2023] Open
Abstract
This study aimed to evaluate the emotional path, impact on everyday life, and adequacy of patient education throughout the diagnostic and therapeutic journey of women who received a positive human papillomavirus (HPV) test or Pap smear result.An online survey was designed to determine the demographic characteristics, dominant feelings throughout the diagnostic and therapeutic procedures, major lifestyle changes, impact on social life, and perceived adequacy of patient information in Italian women with a positive HPV test or abnormal cervical cytology result. In this study, the phases of the "patient's journey" included the initial test, waiting for colposcopy or biopsy, waiting for surgery, and follow-up.Anxiety, worry, and fear were the most frequently cited emotions during the initial tests and intervals between procedures. Anxiety and fear gradually decreased during the journey until surgery, and higher levels of optimism were observed postsurgery. The most frequently reported lifestyle changes were attempts to boost the immune system, increased precautions in sexual practices, and dietary changes. Social life is affected by changes in sexual and intimate relationships with partners. Women reported receiving insufficient patient education on the diagnosis and its implications, progression, management, personal care, and resolution.Significant attention should be given to the psychosocial aspects of the entire patient journey after receiving a positive HPV test or an abnormal Pap smear result. It is essential to establish a good rapport between patients and healthcare professionals, and to educate women regarding the condition by minimizing the gap between the perceived and desired adequacy of information.
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Affiliation(s)
- Andrea Ciavattini
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Giovanni Delli Carpini
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Luca Giannella
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Anna Del Fabro
- Centro di Riferimento Oncologico di Aviano-IRCCS, SOC Chirurgia Oncologica Ginecologica, Aviano, Italy
| | - Vivek Banerji
- Insight Dojo, Studio 206, The Print Rooms, 164-180 Union Street, London, UK
| | - Genevieve Hall
- Insight Dojo, Studio 206, The Print Rooms, 164-180 Union Street, London, UK
| | - Maggiorino Barbero
- Azienda Sanitaria Locale di Asti, SOC Ostetricia e Ginecologia, Asti, Italy
| | - Francesco Sopracordevole
- Centro di Riferimento Oncologico di Aviano-IRCCS, SOC Chirurgia Oncologica Ginecologica, Aviano, Italy
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Cyr PR, Pedersen K, Iyer AL, Bundorf MK, Goldhaber-Fiebert JD, Gyrd-Hansen D, Kristiansen IS, Burger EA. Providing more balanced information on the harms and benefits of cervical cancer screening: A randomized survey among US and Norwegian women. Prev Med Rep 2021; 23:101452. [PMID: 34221852 PMCID: PMC8242055 DOI: 10.1016/j.pmedr.2021.101452] [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: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 11/26/2022] Open
Abstract
Additional information did not impact intentions to participate in CC screening. Additional information increased uncertainty to seek precancer treatment in Norway. Women reported strong system-specific preferences for sources of information. Having a prior Pap-test was an important predictor of intentions-to-participate. Socioeconomic factors influenced follow-up intentions in the U.S. but not in Norway.
We aimed to identify how additional information about benefits and harms of cervical cancer (CC) screening impacted intention to participate in screening, what type of information on harms women preferred receiving, from whom, and whether it differed between two national healthcare settings. We conducted a survey that randomized screen-eligible women in the United States (n = 1084) and Norway (n = 1060) into four groups according to the timing of introducing additional information. We found that additional information did not significantly impact stated intentions-to-participate in screening or follow-up testing in either country; however, the proportion of Norwegian women stating uncertainty about seeking precancer treatment increased from 7.9% to 14.3% (p = 0.012). Women reported strong system-specific preferences for sources of information: Norwegians (59%) preferred it come from a national public health agency while Americans (59%) preferred it come from a specialist care provider. Regression models revealed having a prior Pap-test was the most important predictor of intentions-to-participate in both countries, while having lower income reduced the probabilities of intentions-to-follow-up and seek precancer treatment among U.S. women. These results suggest that additional information on harms is unlikely to reduce participation in CC screening but could increase decision uncertainty to seek treatment. Providing unbiased information would improve on the ethical principle of respect for autonomy and self-determination. However, the clinical impact of additional information on women’s understanding of the trade-offs involved with CC screening should be investigated. Future studies should also consider country-specific socioeconomic barriers to screening if communication re-design initiatives aim to improve CC screening participation.
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Affiliation(s)
- P R Cyr
- Department of Global Health and Community Medicine, Institute of Health and Society, University of Oslo, P.O. Box 1039 Blindern, 0318 Oslo, Norway
| | - K Pedersen
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P.O. Box 1039 Blindern, 0318 Oslo, Norway
| | - A L Iyer
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P.O. Box 1039 Blindern, 0318 Oslo, Norway
| | - M K Bundorf
- Stanford School of Public Policy, Duke University, Durham, NC 27708 and NBER, United States
| | - J D Goldhaber-Fiebert
- Centers for Health Policy and Primary Care and Outcomes Research, Stanford Health Policy, Stanford University, Stanford, CA, United States
| | - D Gyrd-Hansen
- Danish Centre for Health Economic, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9B, 1 Floor, 5000, Odense C, Denmark
| | - I S Kristiansen
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P.O. Box 1039 Blindern, 0318 Oslo, Norway
| | - E A Burger
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P.O. Box 1039 Blindern, 0318 Oslo, Norway
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Qaderi K, Geranmayeh M, Farnam F, Sheikh Hasani S, Mirmolaei ST. Understanding HPV-positive women's needs and experiences in relation to patient-provider communication issues: a qualitative study. BMC Health Serv Res 2021; 21:286. [PMID: 33784992 PMCID: PMC8011207 DOI: 10.1186/s12913-021-06283-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/15/2021] [Indexed: 11/29/2022] Open
Abstract
Background HPV testing has been integrated in cervical cancer screening program. Patient-providers relationship is extremely important to improve cervical cancer screening outcomes. This qualitative study aims to understand HPV-positive women’s needs and preferences about HCPs and patient-provider communication based on their experiences of accessing primary and specialized care. Methods We conducted 40 semi-structured interviews with HPV-positive women. Recorded interviews transcribed and analyzed using conventional content analysis approach. Results The analysis of the data led to the extraction of three main categories, including: provider’s communication and counseling skills, commitment to professional principles, and knowledgeable and competent provider. Women needed understandable discussion about HPV, emotional support and acceptance, receiving HPV-related guidance and advice, and some considerations during clinical appointments. Women needed HCPs to treat them respectfully, gently and with non-judgmental attitude. “Precancerous” and “high-risk” words and watching colposcopy monitor during procedure had made women anxious. Weak referral system and limited interactions among gynecologists and other HCPs highlighted by participants. Conclusion The results of this study, based on the experiences and perceptions of HPV women receiving health care, contain messages and practical tips to healthcare providers at the primary and specialized levels of care to facilitate patient-provider communication around HPV. Providers need to approach the discussion of HPV with sensitivity and take individual needs and preferences into account to improve the HPV-positive women’s healthcare experience. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06283-w.
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Affiliation(s)
- Kowsar Qaderi
- Reproductive Health Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Eastern Nosrat st. Tohid sq, Tehran, 141973317, Iran
| | - Mehrnaz Geranmayeh
- Reproductive Health Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Eastern Nosrat st. Tohid sq, Tehran, 141973317, Iran
| | - Farnaz Farnam
- Reproductive Health Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Eastern Nosrat st. Tohid sq, Tehran, 141973317, Iran
| | - Shahrzad Sheikh Hasani
- Gynecology Oncology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Seyedeh Tahereh Mirmolaei
- Reproductive Health Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Eastern Nosrat st. Tohid sq, Tehran, 141973317, Iran.
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Thomsen LT, Kjær SK, Munk C, Frederiksen K, Ørnskov D, Waldstrøm M. Clinical Performance of Human Papillomavirus (HPV) Testing versus Cytology for Cervical Cancer Screening: Results of a Large Danish Implementation Study. Clin Epidemiol 2020; 12:203-213. [PMID: 32110112 PMCID: PMC7041597 DOI: 10.2147/clep.s243546] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 02/05/2020] [Indexed: 12/26/2022] Open
Abstract
Background Human papillomavirus (HPV) testing is increasingly used as the primary cervical cancer screening test. In a large pilot implementation, we compared participation, referrals and detection of high-grade cervical intraepithelial neoplasia (CIN) in HPV- versus cytology-based cervical cancer screening. Methods The implementation was embedded into the routine screening program at Lillebaelt Hospital, Department of Pathology, Vejle, Denmark. Based on the area of residence, women aged 30–59 years were screened by either HPV testing (with HPV16/18 genotyping and cytology triage) or cytology (with HPV triage for minor abnormalities). Our analysis includes women invited or screened during May 2017–May 2018 (invited: n=35,081; screened: n=28,352) with 6 months of follow-up. Information on screening results and sociodemographic characteristics were obtained from registers. Using logistic regression, we estimated odds ratios (ORs) with 95% confidence intervals (CIs) of participation, referral and CIN3+-detection in HPV- versus cytology-based screening, adjusting for sociodemographic characteristics. Results Participation was virtually identical in the HPV- and cytology group (58.4% vs 58.8%; ORadjusted=0.97, 95% CI, 0.93–1.01). Referral to colposcopy was more common in the HPV- than cytology group (3.8% vs 2.1%; ORadjusted=1.88, 95% CI, 1.63–2.17). More cases of CIN3+ were detected in the HPV- than cytology group (1.0% vs 0.7%, ORadjusted=1.47; 95% CI, 1.13–1.91). Conclusion Participation did not differ between HPV- and cytology-based screening. HPV-based screening detected more cases of CIN3+, but in this initial screening round also led to more colposcopies than cytology-based screening.
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Affiliation(s)
- Louise T Thomsen
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne K Kjær
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Gynecology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christian Munk
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kirsten Frederiksen
- Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Dorthe Ørnskov
- Department of Pathology, Vejle Hospital, Lillebaelt Hospital, Region of Southern Denmark, Vejle, Denmark
| | - Marianne Waldstrøm
- Department of Pathology, Vejle Hospital, Lillebaelt Hospital, Region of Southern Denmark, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Thompson EL, Galvin AM, Daley EM, Tatar O, Zimet GD, Rosberger Z. Recent changes in cervical cancer screening guidelines: U.S. women's willingness for HPV testing instead of Pap testing. Prev Med 2020; 130:105928. [PMID: 31756351 DOI: 10.1016/j.ypmed.2019.105928] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 10/04/2019] [Accepted: 11/18/2019] [Indexed: 12/14/2022]
Abstract
Cervical cancer screening guidelines in the United States were revised in 2018 to include the option of primary human papillomavirus (HPV) testing. The transition to this screening method may face difficulties as Pap testing has been the primary screening modality in the United States. The objective of this study is to assess information, motivation, and behavioral skills associated with willingness to receive an HPV test instead of a Pap test among women. The sample included U.S. 812 women, ages 30 to 65 years. Participants completed an online survey in 2018. The Information, Motivation, and Behavioral Skills (IMB) model was used to measure predictors of willingness for HPV testing. The outcome variables were willingness to receive the HPV test instead of the Pap test, with and without time interval details. Logistic regression modeling was used with SAS 9.4. Over half of the sample (55%) were willing to receive the HPV test. For the information domain, HPV knowledge was significantly associated with willingness for HPV testing (OR = 1.08, 95%CI 1.04-1.13). Significant motivating factors included: positive attitudes, social norms, perceived benefits, worry about cervical cancer, and worry about abnormal HPV tests. For behavioral skills, women were significantly more willing to get the HPV test if a provider recommended it (OR = 2.43, 95%CI 1.53-3.87) and currently up-to-date on cervical cancer screening guidelines (OR = 1.52, 95%CI 1.52-2.26). Addressing barriers and facilitators to willingness to transition to primary HPV testing over Pap testing is needed as the United States has updated guidelines for cervical cancer screening.
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Affiliation(s)
- Erika L Thompson
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, TX, USA.
| | - Annalynn M Galvin
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Ellen M Daley
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Ovidiu Tatar
- Research Center-Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Gregory D Zimet
- Indiana University School of Medicine, Division of Adolescent Medicine, Indianapolis, IN, USA
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Departments of Oncology, Psychology, & Psychiatry, McGill University, Montréal, Québec, Canada
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How does information on the harms and benefits of cervical cancer screening alter the intention to be screened?: a randomized survey of Norwegian women. Eur J Cancer Prev 2019; 28:87-95. [PMID: 29595751 DOI: 10.1097/cej.0000000000000436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cervical cancer (CC) is the 13th most frequent cancer among women in Norway, but the third most common among women aged 25-49 years. The national screening program sends information letters to promote screening participation. We aimed to evaluate how women's stated intention to participate in screening and pursue treatment changed with the provision of additional information on harms associated with screening, and to assess women's preferences on the timing and source of such information. We administered a web-based questionnaire to a panel of Norwegian women aged 25-69 years and randomized into three groups on the basis of when in the screening process additional information was introduced: (i) invited for routine screening, (ii) recommended an additional test following detection of cellular abnormalities, and (iii) recommended precancer treatment. A fourth (control) group did not receive any additional information. Results show that among 1060 respondents, additional information did not significantly alter women's stated intentions to screen. However, it created decision uncertainty on when treatment was recommended (8.76-9.09 vs. 9.40; 10-point Likert scale; P=0.004). Over 80% of women favored receiving information on harms and 59% preferred that information come from a qualified public health authority. Nearly 90% of women in all groups overestimated women's lifetime risk of CC. In conclusion, additional information on harms did not alter Norwegian women's stated intention to screen for CC; yet, it resulted in greater decision uncertainty to undergo precancer treatment. Incorporating information on harms into invitation letters is warranted as it would increase women's ability to make informed choices.
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Andreassen T, Hansen BT, Engesaeter B, Hashim D, Støer NC, Tropé A, Moen K, Ursin G, Weiderpass E. Psychological effect of cervical cancer screening when changing primary screening method from cytology to high-risk human papilloma virus testing. Int J Cancer 2019; 145:29-39. [PMID: 30549273 PMCID: PMC6590646 DOI: 10.1002/ijc.32067] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/09/2018] [Accepted: 11/21/2018] [Indexed: 11/23/2022]
Abstract
From 2015, Norway has implemented high‐risk human papilloma virus (hrHPV) testing in primary screening for cervical cancer. Women aged 34–69 years, living in four counties, have been pseudo‐randomly assigned (1:1 randomization) to either hrHPV testing every 5 years (followed by cytology if hrHPV is positive), or cytology testing every 3 years (followed by hrHPV testing if low‐grade cytology is detected). We compared anxiety and depression scores among participants by screening arm and results. In total, 1,008 women answered a structured questionnaire that included the validated Patient Health Questionnaire‐4 (PHQ‐4). The Relative Risk Ratio (RRR) of mild vs. normal anxiety and depression scores, and moderate/severe vs. normal anxiety and depression scores, were estimated by multinomial logistic regression with 95% confidence intervals (95% CIs). Compared to women who were screened with cytology, women randomized to hrHPV testing were not more likely to have mild anxiety and depression scores (RRR 0.96, CI 0.70–1.31) nor more likely to have moderate/severe anxiety and depression scores (RRR 1.14, CI 0.65–2.02). Women with five different combinations of abnormal screening test results were not more likely to have mild or moderate/severe vs. normal anxiety and depression scores than women with normal screening results. The likelihood of having abnormal long‐term (4–24 months after the screening) anxiety or depression scores among women 34 years and older was not affected by screening method or screening results. The results of our study suggest that a change to hrHPV testing in primary screening would not increase psychological distress among participants. What's new? Norway is one of the first countries to implement high‐risk human papilloma virus (hrHPV) testing in primary cervical‐cancer screening. Does this newer type of testing impact the emotional well‐being of patients? In this study, the authors found no significant difference in either anxiety or depression scores between the viral‐screening arm and standard cytology screening. These findings could be useful for other countries considering implementing hrHPV testing, and are reassuring for the ongoing implementation process in Norway.
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Affiliation(s)
- Trude Andreassen
- Cancer Registry of Norway, Institute of PopulationBased Cancer Research, Oslo, Norway.,Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Bo T Hansen
- Cancer Registry of Norway, Institute of PopulationBased Cancer Research, Oslo, Norway
| | - Birgit Engesaeter
- Cancer Registry of Norway, Institute of PopulationBased Cancer Research, Oslo, Norway
| | - Dana Hashim
- Cancer Registry of Norway, Institute of PopulationBased Cancer Research, Oslo, Norway.,Department of Haematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nathalie C Støer
- Oslo University Hospital, Norwegian National Advisory Unit on Women's Health, Oslo, Norway
| | - Ameli Tropé
- Cancer Registry of Norway, Institute of PopulationBased Cancer Research, Oslo, Norway
| | - Kåre Moen
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Giske Ursin
- Cancer Registry of Norway, Institute of PopulationBased Cancer Research, Oslo, Norway.,Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,University of Southern California, Department of Preventive Medicine, Los Angeles, CA
| | - Elisabete Weiderpass
- Cancer Registry of Norway, Institute of PopulationBased Cancer Research, Oslo, Norway.,Folkhälsan Research Centre, Genetic Epidemiology Group, and Faculty of Medicine, Helsinki University, Helsinki, Finland.,Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Tatar O, Thompson E, Naz A, Perez S, Shapiro GK, Wade K, Zimet G, Gilca V, Janda M, Kahn J, Daley E, Rosberger Z. Factors associated with human papillomavirus (HPV) test acceptability in primary screening for cervical cancer: A mixed methods research synthesis. Prev Med 2018; 116:40-50. [PMID: 30172799 DOI: 10.1016/j.ypmed.2018.08.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 07/27/2018] [Accepted: 08/27/2018] [Indexed: 01/14/2023]
Abstract
Primary screening for cervical cancer is transitioning from the longstanding Pap smear towards implementation of an HPV-DNA test, which is more sensitive than Pap cytology in detecting high-risk lesions and offers greater protection against invasive cervical carcinomas. Based on these results, many countries are recommending and implementing HPV testing-based screening programs. Understanding what factors (e.g., knowledge, attitudes) will impact on HPV test acceptability by women is crucial for ensuring adequate public health practices to optimize cervical screening uptake. We used mixed methods research synthesis to provide a categorization of the relevant factors related to HPV primary screening for cervical cancer and describe their influence on women's acceptability of HPV testing. We searched Medline, Embase, PsycINFO, CINAHL, Global Health and Web of Science for journal articles between January 1, 1980 and October 31, 2017 and retained 22 empirical articles. Our results show that while most factors associated with HPV test acceptability are included in the Health Belief Model and/or Theory of Planned Behavior (e.g., attitudes, knowledge), other important factors are not encompassed by these theoretical frameworks (e.g., health behaviors, negative emotional reactions related to HPV testing). The direction of influence of psychosocial factors on HPV test acceptability was synthesized based on 14 quantitative studies as: facilitators (e.g., high perceived HPV test benefits), barriers (e.g., negative attitudes towards increased screening intervals), contradictory evidence (e.g., sexual history) and no impact (e.g., high perceived severity of HPV infection). Further population-based studies are needed to confirm the impact of these factors on HPV-based screening acceptability.
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Affiliation(s)
- Ovidiu Tatar
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec H3T1E4, Canada.
| | - Erika Thompson
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie, Blvd., EAD 709M, Fort Worth, TX 76107-2699, USA.
| | - Anila Naz
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec H3T1E4, Canada.
| | - Samara Perez
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec H3T1E4, Canada; Department of Psychology, McGill University, 2001 McGill College Avenue, Montreal, Quebec, Canada.
| | - Gilla K Shapiro
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec H3T1E4, Canada; Department of Psychology, McGill University, 2001 McGill College Avenue, Montreal, Quebec, Canada.
| | - Kristina Wade
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec H3T1E4, Canada.
| | - Gregory Zimet
- Indiana University School of Medicine, Section of Adolescent Medicine, 410 West 10th Street, HS 1001, Indianapolis, IN 46202, USA.
| | - Vladimir Gilca
- Institut National de Santé Publique du Québec, 945 Wolfe Avenue, Québec, Quebec G1V 5B3, Canada.
| | - Monika Janda
- Queensland University of Technology, Faculty of Health, Brisbane, Australia.
| | - Jessica Kahn
- University of Cincinnati (Ohio), Division of Adolescent and Transition Medicine, MLC 4000, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA.
| | - Ellen Daley
- University of South Florida, Department of Community and Family Health, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL 33612, USA.
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec H3T1E4, Canada; Department of Psychology, McGill University, 2001 McGill College Avenue, Montreal, Quebec, Canada.
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Phuakpoolpol S, Suwannarurk K, Jaisin K, Punyashthira A, Pattaraarchachai J, Bhamarapravatana K. Anxiety and Depression in Thai Women with Abnormal Cervical Cytology who Attended Colposcopic Unit in Thammasat University Hospital. Asian Pac J Cancer Prev 2018; 19:2985-2989. [PMID: 30362338 PMCID: PMC6291034 DOI: 10.22034/apjcp.2018.19.10.2985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Colposcopy is the standard investigation for women with abnormal cervical cytology. Waiting time
to colposcopy could impact to psychological distress. Data about anxiety and depression in eastern countries patients
were limited. Aim of this investigation was to evaluate anxiety and depression status in Thai women who were waiting
for colposcopy compared to women who attended gynecology clinic for cervical cancer screening. Materials and
methods: This study was conducted at the outpatient gynecology clinic of Thammasat University Hospital between
January 2017 to March 2018. A Total of 200 women were recruited into the study. The cases were divided into the study
and control group. Study group consisted of one hundred women with abnormal cervical cytology referred to colposcopy.
One hundred of women who attended gynecology clinic for cervical cancer screening was classified as control group.
The Hospital Anxiety and Depression Scale (HADS) was used to determine anxiety in the participants. Results: Total
of 200 women who met criteria of the study were recruited. The mean ages of both groups were 40 years old. Both
groups were significantly different when it came to their education, 30 and 59 percent of study and control group had
education level more than bachelor (p=0.003). The prevalence of anxiety was statistically significantly higher in study
group than the control group (15% and 6%, respectively). There was only one case of depression in study. Waiting time
and abnormal cervical cytology severity did not affected to anxiety level. Conclusions: Colposcopy and appointment
caused anxiety. However anxiety was not associated with waiting time to colposcopy or Pap result’s severity.
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Affiliation(s)
- Sasiwimon Phuakpoolpol
- Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
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O'Connor M, O'Leary E, Waller J, Gallagher P, Martin CM, O'Leary JJ, Sharp L. Socio-economic variations in anticipated adverse reactions to testing HPV positive: Implications for the introduction of primary HPV-based cervical screening. Prev Med 2018; 115:90-96. [PMID: 30144488 DOI: 10.1016/j.ypmed.2018.08.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/07/2018] [Accepted: 08/21/2018] [Indexed: 11/18/2022]
Abstract
Some cervical cancer screening programmes are replacing cytology with human papillomavirus (HPV) DNA testing as the primary screening test. Concerns have been previously raised around the potential psychosocial impact of testing positive for HPV. We analysed socio-economic variations in anticipated adverse reactions to testing positive for HPV in women of screening age in the general population. A questionnaire was mailed to a random sample of 5553 women aged 20-64 in 2010, selected through primary care in Ireland. This included questions on: socio-economics; HPV knowledge; and women's anticipated adverse psychosocial responses to testing HPV positive (shame, anxiety, stigma and worry). Multivariable linear regression was used to identify socio-economic factors significantly associated with each anticipated adverse reaction. The response rate was 62% (n = 3470). In multivariate analyses, having only attained primary level education were significantly associated with higher mean scores for all four adverse outcomes. Religion was significantly associated with all four adverse outcomes. Age was associated with anxiety and worry; younger women (<30 years) had the highest mean scores. Being married/cohabiting was significantly associated with significantly lower shame and worry scores. Not working was significantly associated with higher mean anxiety and worry scores. Our large population-based survey found significant socio-economic variations in anticipated adverse reactions to testing HPV positive. In order to minimise possible negative impacts on screening uptake and alleviate potential adverse psychological effects of HPV-based screening on women, screening programmes may need to develop specific messages around HPV infection and HPV screening that target certain subgroups of women.
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Affiliation(s)
| | - Eamonn O'Leary
- National Cancer Registry Ireland, Kinsale Road, Cork, Ireland
| | - Jo Waller
- Department of Behavioural Science and Health, University College London, London, UK
| | - Pamela Gallagher
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Cara M Martin
- Department of Histopathology, University of Dublin, Trinity College, Ireland; Department of Pathology, Coombe Women and Infants University Hospital, Ireland, Ireland
| | - John J O'Leary
- Department of Histopathology, University of Dublin, Trinity College, Ireland; Department of Pathology, Coombe Women and Infants University Hospital, Ireland, Ireland
| | - Linda Sharp
- Institute of Health & Society, Newcastle University, UK
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Musa J, Achenbach CJ, O’Dwyer LC, Evans CT, McHugh M, Hou L, Simon MA, Murphy RL, Jordan N. Effect of cervical cancer education and provider recommendation for screening on screening rates: A systematic review and meta-analysis. PLoS One 2017; 12:e0183924. [PMID: 28873092 PMCID: PMC5584806 DOI: 10.1371/journal.pone.0183924] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 08/14/2017] [Indexed: 01/01/2023] Open
Abstract
Background Although cervical cancer is largely preventable through screening, detection and treatment of precancerous abnormalities, it remains one of the top causes of cancer-related morbidity and mortality globally. Objectives The objective of this systematic review is to understand the evidence of the effect of cervical cancer education compared to control conditions on cervical cancer screening rates in eligible women population at risk of cervical cancer. We also sought to understand the effect of provider recommendations for screening to eligible women on cervical cancer screening (CCS) rates compared to control conditions in eligible women population at risk of cervical cancer. Methods We used the PICO (Problem or Population, Interventions, Comparison and Outcome) framework as described in the Cochrane Collaboration Handbook to develop our search strategy. The details of our search strategy has been described in our systematic review protocol published in the International Prospective Register of systematic reviews (PROSPERO). The protocol registration number is CRD42016045605 available at: http://www.crd.york.ac.uk/prospero/display_record.asp?src=trip&ID=CRD42016045605. The search string was used in Pubmed, Embase, Cochrane Systematic Reviews and Cochrane CENTRAL register of controlled trials to retrieve study reports that were screened for inclusion in this review. Our data synthesis and reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). We did a qualitative synthesis of evidence and, where appropriate, individual study effects were pooled in meta-analyses using RevMan 5.3 Review Manager. The Higgins I2 was used to assess for heterogeneity in studies pooled together for overall summary effects. We did assessment of risk of bias of individual studies included and assessed risk of publication bias across studies pooled together in meta-analysis by Funnel plot. Results Out of 3072 study reports screened, 28 articles were found to be eligible for inclusion in qualitative synthesis (5 of which were included in meta-analysis of educational interventions and 8 combined in meta-analysis of HPV self-sampling interventions), while 45 were excluded for various reasons. The use of theory-based educational interventions significantly increased CCS rates by more than double (OR, 2.46, 95% CI: 1.88, 3.21). Additionally, offering women the option of self-sampling for Human Papillomavirus (HPV) testing increased CCS rates by nearly 2-fold (OR = 1.71, 95% CI: 1.32, 2.22). We also found that invitation letters alone (or with a follow up phone contact), making an appointment, and sending reminders to patients who are due or overdue for screening had a significant effect on improving participation and CCS rates in populations at risk. Conclusion Our findings supports the implementation of theory-based cervical cancer educational interventions to increase women’s participation in cervical cancer screening programs, particularly when targeting communities with low literacy levels. Additionally, cervical cancer screening programs should consider the option of offering women the opportunity for self-sample collection particularly when such women have not responded to previous screening invitation or reminder letters for Pap smear collection as a method of screening.
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Affiliation(s)
- Jonah Musa
- Health Sciences Integrated PhD Program, Center for Healthcare Studies, Institute of Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
- Center for Global Health, Institute of Public Health and Medicine, Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Jos, Jos, Plateau State, Nigeria
- * E-mail: , ,
| | - Chad J. Achenbach
- Center for Global Health, Institute of Public Health and Medicine, Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
| | - Linda C. O’Dwyer
- Galter Health Sciences Library, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
| | - Charlesnika T. Evans
- Department of Preventive Medicine, Center for Health Care Studies, Global Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, Illinois, United States of America
| | - Megan McHugh
- Health Sciences Integrated PhD Program, Center for Healthcare Studies, Institute of Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
| | - Lifang Hou
- Division of Cancer Epidemiology, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
| | - Melissa A. Simon
- Department of Obstetrics and Gynecology, Preventive Medicine and Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
| | - Robert L. Murphy
- Center for Global Health, Institute of Public Health and Medicine, Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
| | - Neil Jordan
- Health Sciences Integrated PhD Program, Center for Healthcare Studies, Institute of Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
- Department of Preventive Medicine, Center for Health Care Studies, Global Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Department of Psychiatry & Behavioral Science, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
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Chen SL, Tsai SF, Hsieh MM, Lee LL, Tzeng YL. Factors Predicting Nurse Intent and Status Regarding Pap Smear Examination in Taiwan: a Cross-sectional Survey. Asian Pac J Cancer Prev 2016; 17:165-70. [PMID: 26838204 DOI: 10.7314/apjcp.2016.17.1.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nurses are the most visible, frontline personnel providing health education to patients. In particular, nurse experience with Pap examinations have the potential to influence women's attitudes toward screening for cervical cancer. However, nurses in Taiwan have lower rates of Pap testing than the general population. Understanding the factors predicting nurse intent to have a Pap exam and Pap exam status would inform interventions and policies to increase their Pap exam uptake. Therefore, the present study was undertaken. MATERIALS AND METHODS Data were collected by questionnaire from a convenient sample of 504 nurses at a regional hospital in central Taiwan between August and October 2011 and analyzed by descriptive statistics, confirmatory factor analysis, and logistic regression. RESULTS Nurse intention to have a Pap exam was predicted by younger age, less negative attitudes toward Pap exams, and greater influence of others recommendations. However, nurses were more likely to actually have had a Pap exam if they were older, married, had sexual experience, and had a high intention to have a Pap exam. CONCLUSIONS Nurses who are younger than 34 years old, unmarried, sexually inexperienced, and with low intention to have a Pap exam should be targeted with interventions to educate them not only about the importance of Pap exams in detecting cervical cancer, but also about strategies to decrease pain and embarrassment during exams. Nurses with less negative attitudes and experiences related to Pap exams would serve as role models to persuade women to have Pap exams, thus increasing the uptake rate of Pap exams in Taiwan.
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Affiliation(s)
- Shu-Ling Chen
- Department of Nursing, Hungkuang University, Taichung, Taiwan E-mail :
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