BACKGROUND:Women with mild dyskaryosis are currently managed by six-month cytological surveillance. While there is good evidence that women suffer psychological distress on receipt of an abnormal test, and that this is amenable to educational intervention, it remains uncertain whether this distress is prolonged and, if so, how it should best be managed. AIM: To investigate whether a structured educational intervention containing a risk communication package impacts upon psychological sequelae associated with this surveillance. METHOD: A pragmatic cluster-randomized controlled trial during 14 months in 1995 and 1996, based in general practices in Avon and South Glamorgan, that compared the intervention with standard care. Follow-up was by postal questionnaire at six weeks and four months after the screening laboratory had reported the test result. The intervention was an invitation to attend the general practice to consult with a practice nurse trained to deliver the package. The main outcome measures were Spielberger state-anxiety, SF-36 Mental Health dimension, four condition-specific questions regarding concerns about gynaecological health and timing of the repeat smear test, and attendance for the repeat test. RESULTS: Of 514 eligible women, 270 were recruited, of whom 240 returned the six-week questionnaire and 181 returned the four-month questionnaire. On all but one outcome measure, the differences between the groups were not statistically significant. At six-week follow-up, the proportion who preferred the repeat test to be sooner than six months was statistically significantly higher among controls (74% versus 53%; 95% CI = 9% to 33%). At the four-month follow-up, the difference was 7% (95% CI = -7% to 21%). CONCLUSION: There appear to be high levels of anxiety during surveillance for mild dyskaryosis that were not reduced by the intervention. Given that a personally delivered educational intervention designed to reduce anxiety could be viewed as the best available practice, it is of concern that women in the intervention group demonstrated sustained anxiety over a four-month period. The research agenda therefore seems to return to the fundamental question of whether surveillance should be the management of choice.
RCT Entities:
BACKGROUND:Women with mild dyskaryosis are currently managed by six-month cytological surveillance. While there is good evidence that women suffer psychological distress on receipt of an abnormal test, and that this is amenable to educational intervention, it remains uncertain whether this distress is prolonged and, if so, how it should best be managed. AIM: To investigate whether a structured educational intervention containing a risk communication package impacts upon psychological sequelae associated with this surveillance. METHOD: A pragmatic cluster-randomized controlled trial during 14 months in 1995 and 1996, based in general practices in Avon and South Glamorgan, that compared the intervention with standard care. Follow-up was by postal questionnaire at six weeks and four months after the screening laboratory had reported the test result. The intervention was an invitation to attend the general practice to consult with a practice nurse trained to deliver the package. The main outcome measures were Spielberger state-anxiety, SF-36 Mental Health dimension, four condition-specific questions regarding concerns about gynaecological health and timing of the repeat smear test, and attendance for the repeat test. RESULTS: Of 514 eligible women, 270 were recruited, of whom 240 returned the six-week questionnaire and 181 returned the four-month questionnaire. On all but one outcome measure, the differences between the groups were not statistically significant. At six-week follow-up, the proportion who preferred the repeat test to be sooner than six months was statistically significantly higher among controls (74% versus 53%; 95% CI = 9% to 33%). At the four-month follow-up, the difference was 7% (95% CI = -7% to 21%). CONCLUSION: There appear to be high levels of anxiety during surveillance for mild dyskaryosis that were not reduced by the intervention. Given that a personally delivered educational intervention designed to reduce anxiety could be viewed as the best available practice, it is of concern that women in the intervention group demonstrated sustained anxiety over a four-month period. The research agenda therefore seems to return to the fundamental question of whether surveillance should be the management of choice.
Authors: A Lytwyn; J W Sellors; J B Mahony; D Daya; W Chapman; N Ellis; P Roth; A T Lorincz; A Gafni Journal: CMAJ Date: 2000-09-19 Impact factor: 8.262
Authors: Simon J Griffin; Ann-Louise Kinmonth; Marijcke W M Veltman; Susan Gillard; Julie Grant; Moira Stewart Journal: Ann Fam Med Date: 2004 Nov-Dec Impact factor: 5.166
Authors: Rachel M Holloway; Clare Wilkinson; Tim J Peters; Ian Russell; David Cohen; Janine Hale; Cerilan Rogers; Helen Lewis Journal: Br J Gen Pract Date: 2003-08 Impact factor: 5.386
Authors: M Robling; S J Matthews; K Hood; I T Russell; R Holloway; C Wilkinson; A G K Edwards; J Austoker; D Cohen; R Mansel; R M Pill; N C H Stott; A Thapar Journal: Qual Life Res Date: 2002-06 Impact factor: 4.147
Authors: Thomas Everett; Andrew Bryant; Michelle F Griffin; Pierre Pl Martin-Hirsch; Carol A Forbes; Ruth G Jepson Journal: Cochrane Database Syst Rev Date: 2011-05-11
Authors: Rona Campbell; Nicola Mills; Emma Sanford; Anna Graham; Nicola Low; Tim J Peters Journal: BMC Public Health Date: 2006-04-25 Impact factor: 3.295