Qualitative insights into the psychological stress before and during colposcopy: a focus group study

Abstract

Objective: To determine the reasons for women’s anxiety and psychological stress before and during colposcopy, in order to define strategies to decrease their stress.

Methods: Qualitative study with 15 women participating in four focus groups between April 2011 and April 2012. All participants were diagnosed with a cervical cytological abnormality and attended a gynecologist’s clinic to undergo colposcopy. The focus group interview was audio-taped and transcribed verbatim. The data were analyzed using qualitative content analysis to identify themes.

Results: Psychological stress before colposcopy was seen as being caused by unsatisfactory explanation of abnormal cervical smears and the colposcopy procedure itself. Additionally, a fear of cancer, pain and discomfort, embarrassment, waiting time in the hospital, and a longer interval between referral and the actual colposcopy appointment increased psychological stress and anxiety. Women indicated that more detailed and practical information about the cervical smear result and the colposcopy procedure may reduce stress and anxiety.

Conclusion: In order to minimize the adverse psychological consequences of an abnormal cervical smear and colposcopy, timely, practical and detailed information needs to be provided to the women, and waiting and access times need to be as short as possible. These measures may reduce the psychological stress and anxiety, however some stress and anxiety will always remain, and may even be desirable in order to ensure proper follow-up of abnormal cervical smears.

• Cervical cancer
• colposcopy
• psychological stress
• psycho-oncology
• qualitative research

Acknowledgements

The authors thank the women who actively participated in the focus groups.

Current knowledge on the subject

• The attendance rate in the cervical cancer screening program in the Netherlands is about 65%; less than 5% of the cervical smears taken are abnormal and will require referral for colposcopy.

• Women referred for colposcopy have a high anxiety level on validated anxiety-questionnaires.

• Recent developments in human papillomavirus (HPV) testing will further complicate the communication of results to screening participants.

What this study adds

• Identifies patient reported reasons for psychological stress before and during a colposcopic appointment, including unsatisfactory communication about the abnormal cervical smear, waiting time in the hospital and unfriendly treatment.

• Confirms patient reported reasons for embarrassment, fear about pain and discomfort during the procedure, and fear of cancer.

• Finds that women would have liked to receive more detailed and practical information beforehand about the procedure in the colposcopy clinic.