Colposcopy information leaflets: what women want to know and when they want to receive this information

Women's experience of colposcopy: a qualitative investigation

BACKGROUND

The last comprehensive investigation of women's experience of the colposcopy service in the UK was conducted in the 1980's. It highlighted women's anxiety and lack of information, resulting in recommendations for improvements. Since then the colposcopy service has changed substantially. It is therefore time to re-visit women's experience of this service and reflect upon the success of service changes in improving experience and reducing anxiety. The aim of this study was to investigate women's experience of being referred for, and attending, colposcopy appointments, and identify potential service improvements.

METHODS

Qualitative in-depth interviews were conducted with 18 women newly referred for colposcopy in the West Midlands, UK. The interviews were designed to elicit the experience of colposcopy from the patients' perspective.

RESULTS

The eight emerging themes were categorised as three overarching concepts, which were: feelings of emotional reaction, choices being accommodated and time delays. Women felt very apprehensive before their appointment, but when attending, appreciated being consulted about their preferences. Delays in referral and feeling 'rushed' by staff impacted negatively on women's experience.

CONCLUSIONS

Service changes in information provision and increased respect for dignity seem to have improved the experience that women have of colposcopy, however, this does not appear to have translated into decreased anxiety. Women still have strong emotional reactions to being referred for, and attending, colposcopy appointments. Staff taking time to explain the diagnosis fully, and discuss their preferences about aspects of their consultation can alleviate their anxiety.

How well informed are women who undergo urodynamic testing?

AIMS

Urodynamic studies (UDS) are complex, invasive and may be emotionally and physically distressing. Inadequate information may heighten distress. Prior to UDS, our patients receive written and verbal information, yet concerns remains that some women may not be adequately informed. This study examined how informed women believe they are to undergo UDS in our clinic.

METHODS

This was a before-after questionnaire-based study. Data were collected from a convenience sample of 200 women prior to UD testing, and within 3 days of completion. Participants rated their level of agreement/disagreement with the following statements: I understand why I am having the test; I have been given enough information about the test; I understand what the test will involve. Women also reported their perceived levels of distress (anxiety, embarrassment, and discomfort).

RESULTS

One hundred fifty-one women returned both pre- and post-UD questionnaires. Most (88.9%) had read the information sheet and agreed that they understood the indications for the testing (78.1%). Fewer agreed that they understood what the tests would involve (68.2%), or that they had been given enough information about the test (64.9%). The overall distress score (anxiety, embarrassment, and discomfort) was 6 (IQR 5-7; possible range 3-9).

CONCLUSIONS

Urodynamic testing remains an invasive yet prevalent form of urogynecological assessment. One-third of our patients may not understand what UD testing involves and may not feel adequately informed about the tests. Additional research to explore informational needs is important.

Synthesising quantitative and qualitative research in evidence-based patient information

BACKGROUND

Systematic reviews have, in the past, focused on quantitative studies and clinical effectiveness, while excluding qualitative evidence. Qualitative research can inform evidence-based practice independently of other research methodologies but methods for the synthesis of such data are currently evolving. Synthesising quantitative and qualitative research in a single review is an important methodological challenge.

AIMS

This paper describes the review methods developed and the difficulties encountered during the process of updating a systematic review of evidence to inform guidelines for the content of patient information related to cervical screening.

METHODS

Systematic searches of 12 electronic databases (January 1996 to July 2004) were conducted. Studies that evaluated the content of information provided to women about cervical screening or that addressed women's information needs were assessed for inclusion. A data extraction form and quality assessment criteria were developed from published resources. A non-quantitative synthesis was conducted and a tabular evidence profile for each important outcome (eg "explain what the test involves") was prepared. The overall quality of evidence for each outcome was then assessed using an approach published by the GRADE working group, which was adapted to suit the review questions and modified to include qualitative research evidence. Quantitative and qualitative studies were considered separately for every outcome.

RESULTS

32 papers were included in the systematic review following data extraction and assessment of methodological quality. The review questions were best answered by evidence from a range of data sources. The inclusion of qualitative research, which was often highly relevant and specific to many components of the screening information materials, enabled the production of a set of recommendations that will directly affect policy within the NHS Cervical Screening Programme.

CONCLUSIONS

A practical example is provided of how quantitative and qualitative data sources might successfully be brought together and considered in one review.