A prospective Swedish cohort study on psychosocial factors influencing anxiety in women referred for colposcopy.
ABSTRACT To elucidate risk factors for high state anxiety in women referred for colposcopy.
Prospective cohort study.
Department of Gynaecology, Malmö University Hospital, Sweden.
A total of 100 consecutive women referred for colposcopy for the first time after an abnormal cervical smear.
Women in the study group completed prior to colposcopy the State-Trait Anxiety Inventory, the Montgomery-Asberg Depression Rating Scale-self-rate, and were interviewed about their psychosocial situation.
Variables related to high state anxiety were determined in bivariate and multiple logistic regression analysis.
High depression scores and the wording of the referral letter for colposcopy were related to high state anxiety in a multivariate analysis. Women with high depression scores had a nine-fold risk for higher levels of state anxiety and did not respond with lower state anxiety levels after information and examination. Women who received a letter stating 'some changes' were at a five-fold increased risk for high levels of state anxiety than those who received a letter stating 'light changes'.
A depressive mood and the wording of the referral letter for colposcopy after an abnormal smear were predictive of high state anxiety levels.
[show abstract] [hide abstract]
ABSTRACT: 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. 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. 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. 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.BMC Women s Health 01/2011; 11:11.