Elsevier

Gynecologic Oncology

Volume 95, Issue 2, November 2004, Pages 341-346
Gynecologic Oncology

Could precolposcopy information and counseling reduce women's anxiety and improve knowledge and compliance to follow-up?

https://doi.org/10.1016/j.ygyno.2004.07.002Get rights and content

Abstract

Objective.

To investigate the effects of precolposcopy counseling on women's anxiety, knowledge about colposcopy and compliance to follow-up.

Methods.

Two hundred and twenty women referred for colposcopy for the first time were recruited. They attended precolposcopy sessions in which written and video information were given and subsequently were randomized to have either further explanation and discussion with an experienced colposcopic nurse (study group) or no further discussion (control group). Each subject completed a Chinese version of the state–anxiety questionnaire (STAI) and a knowledge questionnaire before and immediately after the precolposcopy sessions and also before the colposcopy examination. Women's concern and opinion on the programme were also assessed. Follow-up data was compared with those who did not attend the precolposcopy sessions.

Results.

Women's knowledge about colposcopy significantly improved after the precolposcopy sessions. The improvement was more significant in the study group than in the control group immediately after the sessions (P = 0.003). The difference between the groups in knowledge scores remained statistically significant before colposcopic examination (P = 0.015) but the difference diminished between these two assessment points. There was no statistically significant difference between the two groups in the anxiety scores at all assessment points. Women who attended the precolposcopy sessions had a significantly higher attendance rates and better compliance to follow-up than those who did not attend the sessions.

Conclusion.

Precolposcopy session with explanation and discussion improves women's knowledge about colposcopy, but has negligible effects on women's anxiety before colposcopy. Provision of written and video information at the precolposcopy sessions can improve compliance to follow-up after colposcopy.

Introduction

Most women commonly take an abnormal cervical smear to be indicative of invasive cancer [1]. The receipt of an abnormal result and referral for colposcopy cause high levels of distress [1], [2], [3], [4], [5], [6], [7]. A longitudinal study has shown that the initial colposcopy clinic visit is associated with lowest self-esteem and highest anxiety [1]. This could be due to the limited understanding of the implications of the smear test and the purpose of colposcopy. It has been suggested that provision of information may help these women alleviate anxiety before colposcopy [3], [8]. However, this has never been proven.

The ideal medium for the provision of information is also unclear. It has been noted that sending an information leaflet before colposcopy alone is not beneficial [9]. Passive information alone may improve the patient's knowledge but not reduce her anxiety [10]. In a study investigating different methods of information giving before cancer screening, the use of visual teaching aids has been found to be more effective than verbal or written information to improve knowledge [11].

It has been suggested that counseling sessions before the clinic visit may help to reduce anxiety at the time of colposcopy [12]. We therefore performed this study to investigate the effects of precolposcopy counseling provided by an experienced colposcopic nurse on women's anxiety, knowledge about colposcopy and their compliance to the clinic follow-up.

Section snippets

Materials and methods

This was a prospective randomized study conducted in our colposcopy clinic. It was carried out after the approval of the Institutional Review Board of our hospital. When a woman was referred for colposcopy, a precolposcopy appointment would be given to the woman together with the colposcopy appointment. The precolposcopy appointment was about 1–2 weeks before the actual colposcopy session. The precolposcopy sessions were held in the colposcopy clinic, on Saturday afternoon.

During the

Results

Between July 2001 and December 2002, there were 1219 new referrals for abnormal smears. Most women did not come to the precolposcopy sessions because of “no time” or “no interest”. Among the 247 women who attended, 232 were eligible and were asked to participate. Four women refused to fill in the questionnaires and eight indicated no interest to participate in the study. The remaining 220 women were recruited into and completed the trial.

Table 1 summarizes the patient characteristics. Patients'

Discussion

This is a randomized controlled study investigating the effects of a precolposcopy session provided by an experienced colposcopic nurse in women attending colposcopy clinic. Our findings are consistent with studies conducted previously showing a high level of anxiety in women being referred for colposcopy for abnormal smears, with a mean baseline anxiety score of 45.98 (45.56 for the control group and 46.38 for the study group). This is similar to the level of anxiety found in other studies,

Conclusions

Precolposcopy session with explanation and discussion by an experienced colposcopic nurse improves women's knowledge about colposcopy, but this cannot relieve women's anxiety before colposcopy. Provision of written and video information at the precolposcopy sessions can improve compliance to follow-up after colposcopy.

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