Advertisement

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

      Abstract

      Background

      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.

      Methods

      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.

      Results

      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.

      Conclusions

      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.
      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Women's Health Issues
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bonevski B.
        • Sanson-Fisher R.
        • Girgis A.
        • Perkins J.
        Women's experiences of having a colposcopic examination: Self-reported satisfaction with care, perceived needs and consequences.
        Journal of Obstetrics Gynaecology. 1998; 18: 462-470
        • Bosgraaf R.P.
        • de Jager W.C.
        • Servaes P.
        • Prins J.B.
        • Massuger L.F.
        • Bekkers R.L.
        Qualitative insights into the psychological stress before and during colposcopy: A focus group study.
        Journal of Psychosomatic Obstetrics and Gynaecology. 2013; 34: 150-156
        • Braun V.
        • Clarke V.
        Using thematic analysis in psychology.
        Qualitative Research in Psychology. 2006; 3: 77-101
        • Castanon A.
        • Brocklehurst P.
        • Evans H.
        • Peebles D.
        • Singh N.
        • Walker P.
        • Sasieni P.
        • et al.
        Risk of preterm birth after treatment for cervical intraepithelial neoplasia among women attending colposcopy in England: Retrospective-prospective cohort study.
        BMJ. 2012; 345: e5174
        • CervicalCheck
        CervicalCheck Programme Report 2011-2012.
        National Cancer Screening Service, Ireland2014 (Available:) (Accessed September 15, 2014)
        • Francis J.J.
        • Johnston M.
        • Robertson C.
        • Glidewell L.
        • Entwistle V.
        • Eccles M.P.
        • Grimshaw J.M.
        What is an adequate sample size? Operationalising data saturation for theory-based interview studies.
        Psychology & Health. 2010; 25: 1229-1245
        • Galaal K.
        • Bryant A.
        • Deane K.H.
        • Al-Khaduri M.
        • Lopes A.D.
        Interventions for reducing anxiety in women undergoing colposcopy.
        Cochrane Database of Systematic Reviews. 2011; : CD006013
        • Gray N.M.
        • Sharp L.
        • Cotton S.,C.
        • Masson L.F.
        • Little J.
        • Walker L.G.
        • Woolley C.M.
        • et al.
        Psychological effects of a low-grade abnormal cervical smear test result: Anxiety and associated factors.
        British Journal of Cancer. 2006; 94: 1253-1262
        • Hathaway D.
        Effect of preoperative instruction on postoperative outcomes: A meta-analysis.
        Nursing Research. 1986; 35: 269-275
        • Hellsten C.
        • Sjostrom K.
        • Lindqvist P.G.
        A 2-year follow-up study of anxiety and depression in women referred for colposcopy after an abnormal cervical smear.
        BJOG. 2008; 115: 212-218
        • Jordan J.
        • Arbyn M.
        • Martin-Hirsch P.
        • Schenck U.
        • Baldauf J.J.
        • Da Silva D.
        • Prendiville W.
        • et al.
        European guidelines for quality assurance in cervical cancer screening: Recommendations for clinical management of abnormal cervical cytology, part 1.
        Cytopathology. 2008; 19: 342-354
        • Kitchener H.C.
        • Burns S.
        • Nelson L.
        • Myers A.J.
        • Fletcher I.
        • Desai M.
        • Maguire P.
        • et al.
        A randomised controlled trial of cytological surveillance versus patient choice between surveillance and colposcopy in managing mildly abnormal cervical smears.
        BJOG. 2004; 111: 63-70
        • Massad L.S.
        • Einstein M.H.
        • Huh W.K.
        • Katki H.A.
        • Kinney W.K.
        • Schiffman M.
        • Lawson H.W.
        • et al.
        2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors.
        Journal of Lower Genital Tract Disease. 2013; 5: 1-27
        • Mattson M.
        • Gibb Hall J.
        Linking health communication with social support.
        in: Health as communication nexus: A service-learning approach. Kendall Hunt Publishing Company, Dubuqe, IA2011
        • National Health and Medical Research Council (NHMRC)
        Screening to prevent cervical cancer: Guidelines for the management of asymptomatic women with screen detected abnormalities.
        Australian Government, Australia2005 (Available:) (Accessed October 10, 2014)
        • National Health Service (NHS)
        Cervical screening programme, England 2012-13.
        Health and Social Care Information Centre, England2013 (Available:) (Accessed October 14, 2014)
        • National Services Division
        Cervical screening programme, background.
        NHS, National Services Scotland, Scotland2014 (Available:) (Accessed September 30, 2014)
        • O'Connor M.
        • White C.
        • Ruttle C.
        • Flannelly G.
        • von Bunau G.
        • O'Leary J.
        • Sharp L.
        • et al.
        Prevalence and predictors of anxiety and worry in women after colposcopy: A longitudinal study.
        Psycho-Oncology. 2013; 22: 363-374
        • Orbell S.
        • Hagger M.
        • Brown V.
        • Tidy J.
        Appraisal theory and emotional sequelae of first visit to colposcopy following an abnormal cervical screening result.
        British Journal of Health Psychology. 2004; 9: 533-555
        • Quilliam S.
        Positive smear. The emotional issues and what can be done.
        Health Education Journal. 1990; 49: 19-20
        • Ritchie J.
        • Spencer L.
        Qualitative data analysis applied policy research.
        in: Bryman A. Burgess R. Analysing qualitative data. Routledge, London1994: 173-194
        • Sharp L.
        • Cotton S.
        • Carsin A.E.
        • Gray N.
        • Thornton A.
        • Cruickshank M.
        • Little J.
        Factors associated with psychological distress following colposcopy among women with low-grade abnormal cervical cytology: a prospective study within the Trial Of Management of Borderline and Other Low-grade Abnormal smears (TOMBOLA).
        Psycho-Oncology. 2013; 22: 368-380
        • Sharp L.
        • Cotton S.
        • Gray N.
        • Avis M.
        • Russell I.
        • Walker L.
        • Little J.
        • et al.
        Long-term psychosocial impact of alternative management policies in women with low-grade abnormal cervical cytology referred for colposcopy: A randomised controlled trial.
        British Journal of Cancer. 2011; 104: 255-264
        • Somerset M.
        • Peters T.J.
        Intervening to reduce anxiety for women with mild dyskaryosis: Do we know what works and why?.
        Journal of Advanced Nursing. 1998; 28: 563-570
        • Spracklen C.N.
        • Harland K.K.
        • Stegmann B.J.
        • Saftlas A.F.
        Cervical surgery for cervical intraepithelial neoplasia and prolonged time to conception of a live birth: A case-control study.
        BJOG. 2013; 120: 960-965
        • Suls J.
        • Wan C.K.
        Effects of sensory and procedural information on coping with stressful medical procedures and pain: a meta-analysis.
        Journal of Consulting and Clinical Psychology. 1989; 57: 372-379
        • Tiersma E.S.
        • van der Lee M.L.
        • Garssen B.
        • Peters A.A.
        • Visser A.P.
        • Fleuren G.J.
        • Goodkin K.
        • et al.
        Psychosocial factors and the course of cervical intra-epithelial neoplasia: a prospective study.
        Gynecologic Oncology. 2005; 97: 879-886
        • Zigmond A.S.
        • Snaith R.P.
        The hospital anxiety and depression scale.
        Acta Psychiatrica Scandinavica. 1983; 67: 361-370

      Biography

      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.

      Biography

      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.

      Biography

      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.

      Biography

      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.

      Biography

      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.

      Biography

      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.

      Biography

      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.

      Biography

      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.

      Biography

      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.