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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Ilic I, Babic G, Dimitrijevic A, Sipetic Grujicic S, Ilic M. Psychological Distress in Women With Abnormal Pap Smear Results Attending Cervical Cancer Screening. J Low Genit Tract Dis 2023; 27:343-350. [PMID: 37535069 DOI: 10.1097/lgt.0000000000000761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
OBJECTIVE Women often experience psychological distress upon receipt of an abnormal Pap test result. This study aimed to evaluate psychological distress and its correlates among women who received an abnormal Pap screening test result. MATERIAL AND METHODS A cross-sectional study was performed in a cohort of 172 consecutive women who had attended screening for cervical cancer and who received abnormal Pap smear results and underwent additional diagnostic procedures (colposcopy/biopsy/endocervical curettage). The participants filled out a questionnaire on sociodemographic variables and the Cervical Dysplasia Distress Questionnaire. Multivariate linear regression was used for the analysis of the data. For multiple comparisons, the Bonferroni correction was applied to adjust the level of significance. RESULTS In women who received an abnormal Pap smear result, the independent correlate of higher psychological distress (by Cervical Dysplasia Distress Questionnaire score) before diagnostic procedures was lower satisfaction with information/support received from other people ( p = .002). Correlates of psychological distress in women older than 40 years with abnormal Pap smear were anxiety ( p = .042) and worry about having cervical cancer, general health and having sex ( p = .044). CONCLUSIONS The authors' findings could enable control of factors predictive of psychological distress in women who received a positive Pap smear screening test before undergoing diagnostic procedures, primarily via active provision of targeted information.
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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
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Uner FO, Korukcu O. A qualitative exploration of fear of cancer recurrence in Turkish cancer survivors who were referred for colposcopy. Health Soc Care Community 2021; 29:729-737. [PMID: 33662170 DOI: 10.1111/hsc.13326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 01/23/2021] [Accepted: 01/30/2021] [Indexed: 06/12/2023]
Abstract
We aimed to qualitatively explore factors related to fear of cancer recurrence in women who had a risk of cervical cancer relapse/metastasis and to identify the psychological effect of gynaecological examination and colposcopy in cancer survivors. We conducted the present descriptive study with a qualitative design based on the thematic analysis approach on ten women who under suspicion of new cancer and were admitted to the Gynaecological Oncology Polyclinic of Akdeniz University for colposcopy between July and October 2017 via in-depth interviews. As a result of the interviews, we identified three main themes: colposcopy-related fear, emotions associated with fear of cancer recurrence, and fear of being diagnosed with cancer. Moreover it was determined that women experienced a fear of death, fear of family being affected, fear of stigmatisation by society, and fear of not coping with the treatment process. We found that women with cancer history and undergoing colposcopy because of abnormal cervical cytology in routine oncology controls experienced a significant fear of cancer recurrence. We found that gynaecological examination and colposcopy caused anxiety in patients. Healthcare professions should be aware and help women to cope with the fear of cancer recurrence in the colposcopy process and should determine the social care needs of these patients.
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Affiliation(s)
- Fatma Ozlem Uner
- Department of Obstetrics and Gynecological Nursing, Faculty of Health, Alaaddin Keykubat University, Alanya, Turkey
| | - Oznur Korukcu
- Department of Obstetrics and Gynecological Nursing, Faculty of Nursing, Akdeniz University, Antalya, Turkey
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Uner FO, Korukcu O. A prevalence and psychometric study on fear of cancer in women with abnormal cervical cytology undergoing colposcopy. Psychooncology 2020; 29:1850-1855. [DOI: 10.1002/pon.5504] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Fatma Ozlem Uner
- Department of Obstetrics and Gynaecology Alanya Alaaddin Keykubat University Alanya Turkey
| | - Oznur Korukcu
- Department of Obstetrics and Gynaecological Nursing Akdeniz University Faculty of Nursing Antalya Turkey
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Saciragic L, Nelson G, Chiarella-Redfern H, Kanarek N, Nation J, Duggan MA. Post-colposcopy Management of ASC-US and LSIL Pap Tests (PALS Trial): Pilot RCT. J Obstet Gynaecol Can 2019; 41:916-25. [PMID: 31230661 DOI: 10.1016/j.jogc.2018.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/09/2018] [Accepted: 08/12/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Evidence supporting optimal follow-up of women with atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesion cytology found to have low-grade disease or normal findings at initial colposcopy is weak. Surveillance options include continued colposcopy, discharge with Pap testing, or HPV testing at 12 months. This study was a pilot RCT comparing these three follow-up policies. The objectives were to determine the feasibility of an RCT and to compare the incidence of greater than or equal to high-grade squamous intraepithelial lesion (≥HSIL) in each of the follow-up policies. METHODS A total of 133 women referred with ASC-US or low-grade squamous intraepithelial lesion cytology between June and August 2012 underwent initial colposcopy where incident ≥HSIL histology was ruled out. Of these women, 125 were randomly assigned to colposcopic surveillance, Pap testing, or HPV testing. Patients with high-risk results at any point were treated according to standard of care. Patient recruitment and adherence to follow-up were calculated using descriptive statistics. Accuracy of the three follow-up arms was calculated (Canadian Task Force Classification: IC). RESULTS Recruitment rates were 80%, and adherence to protocol was 85% to 100%. Nine of 125 (7.2%) patients overall were found to have ≥HSIL histology at exit: one of 43 in the reference colposcopy group, and six of 41 and three of 41 in Pap and HPV arms, respectively. One early cancer was detected in the HPV arm. Sensitivity and specificity (CI) for each arm, respectively, were as follows: colposcopy N/A, 100% (88.1%-100%); Pap, 100% (47.8%-100%) and 85.7% (63.7%-97%); and HPV, 66.7% (9.4%-99.2%) and 68% (46.5%-85.1%). CONCLUSION This pilot study demonstrated the operational and safety feasibility of an RCT in this patient population. Validation of clinical findings is necessary.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Bruhn LV, Andersen SJ, Hariri J. HPV-testing versus HPV-cytology co-testing to predict the outcome after conization. Acta Obstet Gynecol Scand 2018; 97:758-765. [PMID: 29430635 DOI: 10.1111/aogs.13325] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/03/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The purpose of this study was to determine the feasibility of human Papillomavirus (HPV) testing alone as a prognostic tool to predict recurrent disease within a three-year follow-up period after treatment for cervical intraepithelial neoplasia (CIN)2+ . MATERIAL AND METHODS Retrospectively, 128 women with histologically verified CIN2+ who had a conization performed at Southern Jutland Hospital in Denmark between 1 January 2013 and 31 December 2013 were included. Histology, cytology and HPV test results were obtained for a three-year follow-up period. RESULTS 4.7% (6/128) of the cases developed recurrent disease during follow-up. Of the cases without free margins, recurrent dysplasia was detected normal in 10.4% (5/48), whereas in the group with free margins it was 1.3% (1/80). The post-conization HPV test was negative in 67.2% (86/128) and Pap smear normal in 93.7% (120/128). Combining resection margins, cytology and HPV had sensitivity for prediction of recurrent dysplasia of 100%. Specificity was 45.8%, positive predictive value (PPV) 8.5% and negative predictive value (NPV) 100%. Using HPV test alone as a predictor of recurrent dysplasia gave a sensitivity of 83.3%, specificity 69.7%, PPV 11.9% and NPV 98.8%. Combining resection margin and HPV test had a sensitivity of 100%, specificity 45.9%, PPV 8.3% and NPV 100%. CONCLUSION HPV test at six months control post-conization gave an NPV of 98.8% and can be used as a solitary test to identify women at risk for recurrent disease three years after treatment for precursor lesions. Using both resection margin and HPV test had a sensitivity of 100% and NPV 100%. Adding cytology did not increase the predictive value.
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Affiliation(s)
| | | | - Jalil Hariri
- Department of Pathology, Southern Jutland Hospital, Sønderborg, Denmark
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Hillyer GC, Jensen CD, Zhao WK, Neugut AI, Lebwohl B, Tiro JA, Kushi LH, Corley DA. Primary care visit use after positive fecal immunochemical test for colorectal cancer screening. Cancer 2017. [PMID: 28621809 DOI: 10.1002/cncr.30809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND For some patients, positive cancer screening test results can be a stressful experience that can affect future screening compliance and increase the use of health care services unrelated to medically indicated follow-up. METHODS Among 483,216 individuals aged 50 to 75 years who completed a fecal immunochemical test to screen for colorectal cancer at a large integrated health care setting between 2007 and 2011, the authors evaluated whether a positive test was associated with a net change in outpatient primary care visit use within the year after screening. Multivariable regression models were used to evaluate the relationship between test result group and net changes in primary care visits after fecal immunochemical testing. RESULTS In the year after the fecal immunochemical test, use increased by 0.60 clinic visits for patients with true-positive results. The absolute change in visits was largest (3.00) among individuals with positive test results who were diagnosed with colorectal cancer, but significant small increases also were found for patients treated with polypectomy and who had no neoplasia (0.36) and those with a normal examination and no polypectomy performed (0.17). Groups of patients who demonstrated an increase in net visit use compared with the true-negative group included patients with true-positive results (odds ratio [OR], 1.60; 95% confidence interval [95% CI], 1.54-1.66), and positive groups with a colorectal cancer diagnosis (OR, 7.19; 95% CI, 6.12-8.44), polypectomy/no neoplasia (OR, 1.37; 95% CI, 1.27-1.48), and normal examination/no polypectomy (OR, 1.24; 95% CI, 1.18-1.30). CONCLUSIONS Given the large size of outreach programs, these small changes can cumulatively generate thousands of excess visits and have a substantial impact on total health care use. Therefore, these changes should be included in colorectal cancer screening cost models and their causes investigated further. Cancer 2017;123:3744-3753. © 2017 American Cancer Society.
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Affiliation(s)
- Grace Clarke Hillyer
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.,Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons of Columbia University, New York, New York
| | | | - Wei K Zhao
- Division of Research, Kaiser Permanente, Oakland, California
| | - Alfred I Neugut
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.,Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons of Columbia University, New York, New York.,Department of Medicine, College of Physicians and Surgeons of Columbia University, New York, New York
| | - Benjamin Lebwohl
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.,Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons of Columbia University, New York, New York.,Department of Medicine, College of Physicians and Surgeons of Columbia University, New York, New York
| | - Jasmin A Tiro
- Division of Behavioral and Communication Sciences, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente, Oakland, California.,Cancer Research Network, National Cancer Institute, Bethesda, Maryland
| | - Douglas A Corley
- Division of Research, Kaiser Permanente, Oakland, California.,Cancer Research Network, National Cancer Institute, Bethesda, Maryland
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Macdonald M, Lyon R, Smith J, Tidy J, Palmer J. Early colposcopic reassurance and discharge to routine recall does not increase subsequent high-grade referral or treatment rates. Cytopathology 2017; 28:407-412. [PMID: 28752640 DOI: 10.1111/cyt.12453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Jessop Wing Colposcopy Unit identified that between 1st April 2014 and 31st March 2015 the number of women referred with high-grade dyskaryosis and the number of women undergoing treatment increased by 21% and 19%, respectively. There was concern that referral and treatment rates were increasing because we were now seeing women, previously discharged to routine recall with prior low-grade cytology hrHPV positive, re-enter the system for their second round of screening. The aim of this study was to assess the reasons for our significant increase in referral and treatment rates. METHODS A retrospective cohort study performed between 1st April 2012 and 30th June 2015 at the Jessop Wing Colposcopy Unit, Sheffield, UK. RESULTS During the study period, 1765 women underwent large loop excision of the transformation zone (LLETZ), of whom 1517 were referred with high-grade dyskaryosis. Fifty-six (4%) women undergoing treatment; and four untreated high-grade referrals were seen in the previous 3-5 years with low-grade cytology hrHPV positive and discharged to routine recall. There were no cases of invasive disease in the previously discharged groups. There was, however, a significantly higher likelihood of a negative LLETZ (P=.0066) in those women previously discharged to routine recall, and lower rates of CIN2 or worse identified. CONCLUSION Prior discharge to routine recall does not have any major influence on treatment rates or high-grade referrals. The finding of no invasive disease; lower rates of CIN2 or worse; and a significantly higher likelihood of a negative LLETZ in those women previously discharged to routine recall is reassuring and further reinforces the safety of HPV triage pathways.
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Affiliation(s)
- M Macdonald
- Department of Gynaecological Oncology, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - R Lyon
- Jessop Wing Colposcopy, STH NHS Foundation Trust, Sheffield, UK
| | - J Smith
- Department of Histopathology, STH NHS Foundation Trust, Sheffield, UK
| | - J Tidy
- Department of Gynaecological Oncology, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - J Palmer
- Department of Gynaecological Oncology, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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