Adherence to Care Plan in Women With Abnormal Pap Smears
Adherence to Care Plan in Women With Abnormal Pap Smears
Background: Cancer of the cervix is preventable. According to the Surveillance, Epidemiology, and End Results (SEER) Program, invasive cervical cancer incidence is 9.0 and cancer mortality rate is 2.8 per 100,000 persons. Effective prevention includes appropriate use of Papanicolaou smears and adherence to a care plan by the patient. This review will examine the extent of nonadherence, negative outcomes, barriers, and interventions for improved adherence to care.
Methods: Computer searches in MEDLINE for English language articles were conducted from 1968 to 1999 using the key words "colposcopy," "abnormal Papanicolaou smear," "patient compliance," "adherence to care," and "follow-up."
Results: Although there is 10% to 40% nonadherence in the studies reviewed, the definition of nonadherence is not standard. Considerable morbidity from cervical cancer was described among nonadherent women. The most common barriers to follow-up were lack of understanding of the purpose of colposcopy, fear of cancer, forgetting appointments, and lack of time, money, or childcare. Emotional consequences of abnormal Papanicolaou smears had considerable impact on follow-up visits. Focused intervention strategies targeted to the study population were most effective in improving adherence.
Conclusions: Nonadherence results from the interplay of emotional, logistic, cultural, or socioeconomic factors. Among the most effective strategies to improve adherence are personalized reminders to patients by their primary physicians and case management dictated by the size, structure, and style of the practice.
Cervical cancer was once a common cause of death for American women. It is now the ninth most deadly cancer. Despite widespread screening in the United States, in the year 2000 about 12,800 new cases of invasive cervical carcinoma will be diagnosed, and about 4,600 deaths will result from this disease. According to the Surveillance, Epidemiology, and End Results (SEER) Program, the incidence of invasive cervical cancer is 9.0 percent and cancer mortality rate is 2.8 per 100,000 persons.
The Papanicolaou smear was introduced by Papanicolaou in the 1930s and endorsed by the American Cancer Society in 1945 as an important cancer-screening tool. Increased use of the Papanicolaou smear has significantly reduced the number of deaths related to cervical cancer since the 1950s. The Papanicolaou smear itself is one component of a larger cervical cancer prevention system, which includes education, examinations, laboratory testing, and clinical procedures. This system is far from perfect, as shown by continuing morbidity and mortality from a preventable cancer.
Cervical cancer-screening and treatment systems can be deficient in several ways. Cancer screening is underutilized by ethnic minorities, persons living in rural areas, the poor, the uninsured, and the elderly. Failures can result from errors in obtaining appropriate samples, inaccuracy of the test itself, incorrect interpretation of smears, and inaccurate reporting of results. Failures can also occur after the cervical smear results are reported, as shown in Table 1. In addition, aspects of patients' biologic, psychologic, or social spheres can hinder or enhance their ability to adhere to the care plan communicated by their provider.
This review will examine the extent of nonadherence to care plan, the negative outcomes that result, and the studies on barriers to and interventions for improved adherence to care.
Background: Cancer of the cervix is preventable. According to the Surveillance, Epidemiology, and End Results (SEER) Program, invasive cervical cancer incidence is 9.0 and cancer mortality rate is 2.8 per 100,000 persons. Effective prevention includes appropriate use of Papanicolaou smears and adherence to a care plan by the patient. This review will examine the extent of nonadherence, negative outcomes, barriers, and interventions for improved adherence to care.
Methods: Computer searches in MEDLINE for English language articles were conducted from 1968 to 1999 using the key words "colposcopy," "abnormal Papanicolaou smear," "patient compliance," "adherence to care," and "follow-up."
Results: Although there is 10% to 40% nonadherence in the studies reviewed, the definition of nonadherence is not standard. Considerable morbidity from cervical cancer was described among nonadherent women. The most common barriers to follow-up were lack of understanding of the purpose of colposcopy, fear of cancer, forgetting appointments, and lack of time, money, or childcare. Emotional consequences of abnormal Papanicolaou smears had considerable impact on follow-up visits. Focused intervention strategies targeted to the study population were most effective in improving adherence.
Conclusions: Nonadherence results from the interplay of emotional, logistic, cultural, or socioeconomic factors. Among the most effective strategies to improve adherence are personalized reminders to patients by their primary physicians and case management dictated by the size, structure, and style of the practice.
Cervical cancer was once a common cause of death for American women. It is now the ninth most deadly cancer. Despite widespread screening in the United States, in the year 2000 about 12,800 new cases of invasive cervical carcinoma will be diagnosed, and about 4,600 deaths will result from this disease. According to the Surveillance, Epidemiology, and End Results (SEER) Program, the incidence of invasive cervical cancer is 9.0 percent and cancer mortality rate is 2.8 per 100,000 persons.
The Papanicolaou smear was introduced by Papanicolaou in the 1930s and endorsed by the American Cancer Society in 1945 as an important cancer-screening tool. Increased use of the Papanicolaou smear has significantly reduced the number of deaths related to cervical cancer since the 1950s. The Papanicolaou smear itself is one component of a larger cervical cancer prevention system, which includes education, examinations, laboratory testing, and clinical procedures. This system is far from perfect, as shown by continuing morbidity and mortality from a preventable cancer.
Cervical cancer-screening and treatment systems can be deficient in several ways. Cancer screening is underutilized by ethnic minorities, persons living in rural areas, the poor, the uninsured, and the elderly. Failures can result from errors in obtaining appropriate samples, inaccuracy of the test itself, incorrect interpretation of smears, and inaccurate reporting of results. Failures can also occur after the cervical smear results are reported, as shown in Table 1. In addition, aspects of patients' biologic, psychologic, or social spheres can hinder or enhance their ability to adhere to the care plan communicated by their provider.
This review will examine the extent of nonadherence to care plan, the negative outcomes that result, and the studies on barriers to and interventions for improved adherence to care.
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