Psychosocial outcomes of borderline Pap tests

January 01, 0001

Psychosocial outcomes of borderline Pap tests

An abnormal Papanicola smear can result in significant stress and worry for the patient. These Australian researchers examined three triage strategies for women with borderline abnormal Pap smears to determine the psychosocial outcomes. They performed a pragmatic, non-blinded, multicenter, randomised controlled trial in 18 family planning clinics across Australia in various settings involving women aged 16-70 years (n=314). Patients were randomly assigned to human papillomavirus (HPV) DNA testing (n=104), a repeat Pap test in six months (n=106), or the patient’s choice of either test utilizing a decision aid (n=104). Psychosocial outcomes were assessed at multiple time points over by a mailed questionnaire which examined health related quality of life (SF36 mental health subscale), cognitive effects, affective outcomes (state-trait anxiety inventory), specific anxiety about an abnormal smear (cervical screening questionnaire), and other outcomes (sexual health behaviour and visits to the doctor) over one year.

The researchers report: "At two weeks, some psychosocial outcomes were worse for women allocated to HPV testing compared with those in the smear testing group (SF36 vitality subscale: t=-1.63, intrusive thoughts 2=8.14). Over 12 months, distress about the abnormal smear was lowest in women allocated to HPV testing and highest in the repeat smear testing group (t=-2.89, df=135). Intrusive thoughts were highest in patients allocated to HPV testing (25%, compared with 13% in the informed choice group, difference =12%). Women in the HPV DNA group and the informed choice group were more satisfied with their care than women allocated to repeat smear testing."

The researchers concluded: "Although the psychosocial effect was initially worse for women allocated to HPV triage, over the full year of follow-up this intervention was better for women’s psychosocial health than repeat smear testing. Offering informed choice could have a small advantage for cognitive outcomes, but in view of the additional effort and logistical complexity that this intervention requires, HPV testing alone can be justified for most women."

This information looks at important aspect of dealing with abnormal Pap smears beyond the cervical pathology itself, and suggests reflex HPV testing has better long term psychosocial benefits.

For the full abstract, click here.

BMJ 340: b4491, 23 February 2010 © 2010 McCaffery et al.
Psychosocial outcomes of three triage methods for the management of borderline abnormal cervical smears: an open randomised trial. Kirsten J McCaffery, Les Irwig, Robin Turner, et al. Correspondence to Kirsten McCaffery: [email protected]

Category: P. Psychological, X. Female Genital System, Breast. Keywords: HPV, papanicola smear, PAP smear, triage, psychosocial, open randomized trial, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 2 April 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.