Women's triage and management preferences for cervical cytologic reports demonstrating atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesions
D. G. Ferris, D. Kriegel, L. Cote, M. Litaker and L. Woodward
Medical Effectiveness Education and Research Program, Medical College of Georgia, Augusta, USA.
OBJECTIVE: To determine women's triage test preferences for the evaluation
and management of atypical squamous cells of undetermined significance
(ASCUS) and low-grade squamous intraepithelial lesion (LSIL) Papanicolaou
smear reports. DESIGN: A 35-item questionnaire. SETTINGS: Primary care
clinic waiting rooms. PARTICIPANTS: A convenience sample of 968 women.
INTERVENTION: Women received standardized descriptions of the meaning of
ASCUS and LSIL Papanicolaou smear classifications and uniform descriptions
of the 4 triage tests: Papanicolaou smear, human papillomavirus DNA test,
cervicography, and colposcopy. MAIN OUTCOME MEASURES: Subjects' responses
to questionnaire. RESULTS: More women (58.4%) preferred a repeat
Papanicolaou smear for an ASCUS report than would choose human
papillomavirus DNA testing (7.3%), cervicography (20.6%), or colposcopy
(13.8%) (P < .001, chi 2). Alternatively, 51% of women wanted colposcopy
to evaluate an LSIL report compared with the other 3 options (P < .001,
chi 2). Test accuracy was the most important factor that influenced women's
decisions for each test, compared with cost, discomfort, and other reasons
(P < .001, chi 2). Positive predictors for women's selection of
colposcopy to evaluate a Papanicolaou smear showing LSIL included older age
(P < .01, logistic regression analysis), higher level of income (P <
.001, chi 2), greater level of education (P < .001, logistic regression
analysis), greater level of knowledge of colposcopy and Papanicolaou smears
(P < .001, logistic regression analysis), family history of cervical
cancer (P < .01, chi 2), and history of cervical dysplasia (P = .02, chi
2). CONCLUSIONS: Most women preferred a repeat Papanicolaou smear to
further evaluate an initial Papanicolaou smear demonstrating ASCUS and
colposcopy to evaluate a report of LSIL. Women identified test accuracy as
the most important reason for triage test selection. Multiple factors,
primarily involving patient and family history of cervical neoplasia, level
of education, income, age, and knowledge of tests, influence women's desire
for specific triage tests. Because no optimal management of women with
ASCUS and LSIL Papanicolaou smear reports has been determined,
consideration of women's triage test preferences should complement overall
patient care.
