Women's Colposcopy Experience and Preferences: A Mixed Methods Study
Women's Colposcopy Experience and Preferences: A Mixed Methods Study
Background: The colposcopy service is a key component in the UK Cervical Screening Programme. Over 120,000 women are referred to the service annually, however up to 25% of women fail to attend their appointment. Little is known about patients' preferences for colposcopic investigation and treatment. This study aims to investigate women's experience of colposcopy, to identify patients' preferences for aspects of appointments within the colposcopy service, and to make suggestions for service improvement.
Methods/Design: This study has been designed as a two stage, mixed method project. Stage one will involve in-depth interviews with new colposcopy patients to ascertain their experience of colposcopy services. This qualitative stage will generate factors thought to be important by service users in their experience. Stage two will utilise a choice based quantitative technique to identify women's preferences and determine the representativeness of factors generated through the interviews. The initial stage of in-depth interviews will be conducted with patients who are newly referred to colposcopy clinics to investigate the experience that they have of the referral process and appointment attendance. The outcome of these interviews will be analysed qualitatively using Framework analysis. Factors found to be important in women's experience will be extracted and used to construct a choice based questionnaire. The discrete choice experiment (questionnaire) will apply a best-worst technique through scenario-based questions to find women's relative preferences for different aspects of the service. It will be offered to women attending follow-up appointments at two colposcopy clinics in the West Midlands. Women will complete the questionnaire whilst they wait for their appointment, or, if they prefer, will take it home to complete in private. Women who do not attend their appointment will be posted the research information and questionnaire. The questionnaire analysis will use a weighted least squares regression technique for each best/worst pair. The accept/reject 'would you attend this appointment' question will be analysed using a random effects logit model.
Discussion: Colposcopy is a common procedure and one that is associated with raised anxiety among women experiencing the service. Little is known about women's experience of the service or their preferences for service delivery. The outcomes of the study will comprise a description of women's experience of colposcopy and establishing their preferences for how aspects of the service should be provided. Women's preferences will be fed back to service providers to enable improvements to the service to be made.
The cervical screening programme is a key component of UK health policy addressing the primary prevention of cervical cancer. Colposcopy is the accepted procedure for the diagnosis and treatment of abnormal cervical cells. The growing number of abnormal smears referred for colposcopy has increased pressure on services, resulting in prolonged waiting times for patients at such an anxious time.
Colposcopy practice has undergone considerable changes over recent years. Nurse colposcopists have emerged during the last decade in response to increased demands for this service. A retrospective analysis of routinely collected data suggested that nurse colposcopists provide a level of service at least as good as that provided by gynaecologists. Pilot work (Unpublished: Lester H, Luesley D. Psychological trauma of the abnormal smear, in a practice and a hospital setting. BSCCP conference, Glasgow, 1997) has suggested that, compared with a doctor led colposcopy service, many women prefer a nurse led service.
Up to 25% of women fail to attend their initial colposcopy appointment. Factors influencing colposcopy attendance include childcare commitments, fear and anxiety, level of understanding about colposcopy, accessibility of information and when staff attitudes were perceived as insensitive. 'No show' behaviour is more likely in women under 30 years of age or pregnant. There is conflicting evidence on the importance of race, follow up letters or grade of lesion. A review of methods of reducing non-attendance rates (indicating potential deficiencies in the system of service delivery) suggested the need to tailor any intervention to the population and the type of information to the individual. Identification of inequalities in colposcopy provision (e.g. cultural, age based or socio-economic) or any social factors that may inhibit uptake of colposcopy would allow improvements to the service to be identified.
Little is known from the patient perspective regarding preferences for the delivery of colposcopy services. The literature that does exist has either been generated in the US, where access to services may be influenced by women's financial situation, or prior to the introduction of nurse colposcopists. Studies have been carried out investigating women's anxieties regarding cervical screening and colposcopy, but few have investigated their experience of the service as a whole. One early study, undertaken in 1983, found that women experienced considerable emotional upset upon diagnosis of cervical abnormalities, that treatment caused distress, and that it was likely that the sensitivity of the cervix, and stressfulness of the whole procedure, had been underestimated. Recommendations were made at that time for service improvements. Due to changes in the colposcopy service over the last 20 years, the introduction of nurse colposcopists and new techniques, this research now needs updating.
Relatively high rates of non-attendance for appointments (up to 25%) indicate that patient satisfaction may not be being fully addressed with consequent inefficiencies in service delivery. There is a need to investigate the experience women now have of colposcopy appointments in the UK, given the changes to service delivery, high default rates and the potential psychological and emotional cost to women. Investigation of patient experience and preferences provides valuable information that can be fed back to service providers in order to improve the service and ultimately improve patient satisfaction and attendance. In addition to determining the effectiveness of the service offered, it is necessary to establish the appropriateness of delivery from the user perspective; this can only be achieved by more fully understanding women's experiences. This study therefore aims to investigate women's experiences of colposcopy, their preferences and any preconceptions they may have.
The principal research aims are to: 1. Gain an insight into the experience that patients have of the colposcopy service, 2. Identify patient preferences for appointments with the colposcopy service, 3. Make suggestions for service improvements.
Background: The colposcopy service is a key component in the UK Cervical Screening Programme. Over 120,000 women are referred to the service annually, however up to 25% of women fail to attend their appointment. Little is known about patients' preferences for colposcopic investigation and treatment. This study aims to investigate women's experience of colposcopy, to identify patients' preferences for aspects of appointments within the colposcopy service, and to make suggestions for service improvement.
Methods/Design: This study has been designed as a two stage, mixed method project. Stage one will involve in-depth interviews with new colposcopy patients to ascertain their experience of colposcopy services. This qualitative stage will generate factors thought to be important by service users in their experience. Stage two will utilise a choice based quantitative technique to identify women's preferences and determine the representativeness of factors generated through the interviews. The initial stage of in-depth interviews will be conducted with patients who are newly referred to colposcopy clinics to investigate the experience that they have of the referral process and appointment attendance. The outcome of these interviews will be analysed qualitatively using Framework analysis. Factors found to be important in women's experience will be extracted and used to construct a choice based questionnaire. The discrete choice experiment (questionnaire) will apply a best-worst technique through scenario-based questions to find women's relative preferences for different aspects of the service. It will be offered to women attending follow-up appointments at two colposcopy clinics in the West Midlands. Women will complete the questionnaire whilst they wait for their appointment, or, if they prefer, will take it home to complete in private. Women who do not attend their appointment will be posted the research information and questionnaire. The questionnaire analysis will use a weighted least squares regression technique for each best/worst pair. The accept/reject 'would you attend this appointment' question will be analysed using a random effects logit model.
Discussion: Colposcopy is a common procedure and one that is associated with raised anxiety among women experiencing the service. Little is known about women's experience of the service or their preferences for service delivery. The outcomes of the study will comprise a description of women's experience of colposcopy and establishing their preferences for how aspects of the service should be provided. Women's preferences will be fed back to service providers to enable improvements to the service to be made.
The cervical screening programme is a key component of UK health policy addressing the primary prevention of cervical cancer. Colposcopy is the accepted procedure for the diagnosis and treatment of abnormal cervical cells. The growing number of abnormal smears referred for colposcopy has increased pressure on services, resulting in prolonged waiting times for patients at such an anxious time.
Colposcopy practice has undergone considerable changes over recent years. Nurse colposcopists have emerged during the last decade in response to increased demands for this service. A retrospective analysis of routinely collected data suggested that nurse colposcopists provide a level of service at least as good as that provided by gynaecologists. Pilot work (Unpublished: Lester H, Luesley D. Psychological trauma of the abnormal smear, in a practice and a hospital setting. BSCCP conference, Glasgow, 1997) has suggested that, compared with a doctor led colposcopy service, many women prefer a nurse led service.
Up to 25% of women fail to attend their initial colposcopy appointment. Factors influencing colposcopy attendance include childcare commitments, fear and anxiety, level of understanding about colposcopy, accessibility of information and when staff attitudes were perceived as insensitive. 'No show' behaviour is more likely in women under 30 years of age or pregnant. There is conflicting evidence on the importance of race, follow up letters or grade of lesion. A review of methods of reducing non-attendance rates (indicating potential deficiencies in the system of service delivery) suggested the need to tailor any intervention to the population and the type of information to the individual. Identification of inequalities in colposcopy provision (e.g. cultural, age based or socio-economic) or any social factors that may inhibit uptake of colposcopy would allow improvements to the service to be identified.
Little is known from the patient perspective regarding preferences for the delivery of colposcopy services. The literature that does exist has either been generated in the US, where access to services may be influenced by women's financial situation, or prior to the introduction of nurse colposcopists. Studies have been carried out investigating women's anxieties regarding cervical screening and colposcopy, but few have investigated their experience of the service as a whole. One early study, undertaken in 1983, found that women experienced considerable emotional upset upon diagnosis of cervical abnormalities, that treatment caused distress, and that it was likely that the sensitivity of the cervix, and stressfulness of the whole procedure, had been underestimated. Recommendations were made at that time for service improvements. Due to changes in the colposcopy service over the last 20 years, the introduction of nurse colposcopists and new techniques, this research now needs updating.
Relatively high rates of non-attendance for appointments (up to 25%) indicate that patient satisfaction may not be being fully addressed with consequent inefficiencies in service delivery. There is a need to investigate the experience women now have of colposcopy appointments in the UK, given the changes to service delivery, high default rates and the potential psychological and emotional cost to women. Investigation of patient experience and preferences provides valuable information that can be fed back to service providers in order to improve the service and ultimately improve patient satisfaction and attendance. In addition to determining the effectiveness of the service offered, it is necessary to establish the appropriateness of delivery from the user perspective; this can only be achieved by more fully understanding women's experiences. This study therefore aims to investigate women's experiences of colposcopy, their preferences and any preconceptions they may have.
The principal research aims are to: 1. Gain an insight into the experience that patients have of the colposcopy service, 2. Identify patient preferences for appointments with the colposcopy service, 3. Make suggestions for service improvements.
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