Understanding Women's Differing Experiences of Distress after Colposcopy: A Qualitative Interview Study



      Women who have an abnormal cervical cytology test may be referred for a colposcopy. Accumulating evidence suggests some women may experience distress after colposcopy. This exploratory study examined women's differing experiences of post-colposcopy distress with the aim of identifying factors that are predictive of, or protective against, distress.


      We carried out semistructured, qualitative interviews with 23 women who had undergone colposcopies. Interviews were transcribed verbatim, coded, and analyzed thematically. The Framework Approach was used to summarize and organize the data and identify emerging higher order themes.


      Two forms of post-colposcopy distress emerged: 1) short term and 2) long term. Short-term distress was experienced immediately after the colposcopy and in the days afterward, and was usually related to the physical experience of the colposcopy. Long-term distress typically persisted over time and was related to concerns about fertility, cervical cancer, and sexual intercourse. The drivers of short-term and long-term distress differed. Factors related to short-term distress were feeling unprepared for the procedure, having a negative experience of the procedure, and attending the clinic alone. Factors related to long-term distress were future intentions to have (more) children, having physical after-effects of the procedure that impacted on the woman's life, and being under on-going clinic surveillance. Absence of these factors (e.g., being accompanied to the clinic) was protective against short- and long-term distress.


      Colposcopy can lead to short- and long-term post-procedural distress for some women. We identified a range of factors, some potentially modifiable, that seem to influence the chances of experiencing distress. These results may inform the development of strategies or interventions aimed at preventing or minimizing distress after colposcopy and related procedures.
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      Mairead O'Connor, PhD, is a Health Research Board ICE postdoctoral researcher at the National Cancer Registry, Ireland. Her research interests include the psychological impact of cervical cancer screening and the psychosocial implications of HPV infection, testing and vaccination.


      Jo Waller, PhD, is a Cancer Research UK Career Development Fellow working at the Health Behaviour Research Centre, University College London. Her background is in health psychology, and her primary research interest is understanding participation in cervical cancer control programmes.


      Pamela Gallagher, PhD, is Professor of Psychology at the School of Nursing and Human Sciences, Dublin City University. Her principal research interests include psychosocial impacts of illness, disability and loss with particular interest in cancer survivorship.


      Cara M. Martin, PhD, is Assistant Professor of Molecular Pathology at Trinity College Dublin. She leads the Cervical Cancer Group in the Coombe Women and Infant's University Hospital, Dublin. Her research programme consists of translational health services research and approaches in gynaecological cancers.


      John J. O'Leary, MD, PhD, holds positions of Professor of Pathology, Trinity College Dublin, Director of Pathology, the Coombe Women and Infants University Hospital, and Histopathologist, St. James' Hospital, Dublin. His research interests include biomarkers of disease, cervical cancer, molecular pathology and prostate cancer.


      Tom D'Arcy, MD, is a consultant in obstetrics and gynaecology at the Coombe Women and Infant's University Hospital, Dublin. His special interests include clinical obstetrics, gynaecological endoscopy, gynaecological oncology and ovarian cancer screening.


      Walter Prendiville, MD, is Professor of obstetrics/gynaecology at the Royal College of Surgeons Ireland. His areas of interest include minimal access gynaecologic surgery and cervical cancer screening. He is currently a visiting scientist at the Cancer Screening Group in IARC, France.


      Grainne Flannelly, MD, is a consultant in obstetrics and gynaecology at the National Maternity Hospital, Dublin. She is also the clinical director of CervicalCheck, the national cervical screening programme in Ireland. Her research interests include gynaecologic oncology and colposcopy.


      Linda Sharp, PhD, is Professor of Cancer Epidemiology at the Institute of Health & Society, Newcastle University, England. Her research interests include costs and benefits of cancer screening, cancer pharmacoepidemiology and cancer survivorship.