A randomised controlled trial of cytological surveillance versus patient choice between surveillance and colposcopy in managing mildly abnormal cervical smears.

2.50
Hdl Handle:
http://hdl.handle.net/10541/77916
Title:
A randomised controlled trial of cytological surveillance versus patient choice between surveillance and colposcopy in managing mildly abnormal cervical smears.
Authors:
Kitchener, Henry C; Burns, S; Nelson, L; Myers, A J; Fletcher, I; Desai, Mina; Dunn, G; Maguire, Peter
Abstract:
OBJECTIVE: To determine whether choice of colposcopy or six month cytological surveillance would be beneficial to women with mildly abnormal smears when compared with the national policy of six months surveillance in terms of psychological morbidity. DESIGN: A randomised trial based on the Zelen design. SETTING: A hospital-based research clinic. POPULATION: Four hundred and seventy-six women who had had a recurrent borderline or mildly dyskaryotic smear on routine cervical screening in primary care. METHODS: Women were randomised either to six months cytological surveillance or to make a choice between that or colposcopy and were followed up for 1 year. MAIN OUTCOME MEASURES: The primary outcome measure was caseness (score >or=4) on the General Health Questionnaire at 12 months follow up. Other measures were the Spielberger State and Trait scores, default rates and cytology/colposcopy outcomes. RESULTS: There was no significant difference between the arms for General Health Questionnaire (GHQ) scores and Spielberger State and Trait at 12 months. There was a significant reduction in psychometric morbidity between baseline and 12 months in both arms. Overall rates of default from the protocol were the same in both arms, but default that led to uncertain ascertainment of cervical pathology was greater in the no-choice arm. CONCLUSIONS: This trial indicates that having choice did not impact favourably or harmfully on anxiety or feelings of wellbeing. If a patient is anxious, allowing the patient to choose immediate colposcopy may be preferable because it will improve ascertainment of underlying disease in a group who are more likely to default.
Affiliation:
Academic Unit of Obstetrics and Gynaecology, St Mary's Hospital, Manchester, UK.
Citation:
A randomised controlled trial of cytological surveillance versus patient choice between surveillance and colposcopy in managing mildly abnormal cervical smears. 2004, 111 (1):63-70 BJOG
Journal:
BJOG
Issue Date:
Jan-2004
URI:
http://hdl.handle.net/10541/77916
DOI:
10.1046/j.1471-0528.2003.00007.x
PubMed ID:
14687054
Type:
Article
Language:
en
ISSN:
1470-0328
Appears in Collections:
All Christie Publications

Full metadata record

DC FieldValue Language
dc.contributor.authorKitchener, Henry C-
dc.contributor.authorBurns, S-
dc.contributor.authorNelson, L-
dc.contributor.authorMyers, A J-
dc.contributor.authorFletcher, I-
dc.contributor.authorDesai, Mina-
dc.contributor.authorDunn, G-
dc.contributor.authorMaguire, Peter-
dc.date.accessioned2009-08-19T15:30:55Z-
dc.date.available2009-08-19T15:30:55Z-
dc.date.issued2004-01-
dc.identifier.citationA randomised controlled trial of cytological surveillance versus patient choice between surveillance and colposcopy in managing mildly abnormal cervical smears. 2004, 111 (1):63-70 BJOGen
dc.identifier.issn1470-0328-
dc.identifier.pmid14687054-
dc.identifier.doi10.1046/j.1471-0528.2003.00007.x-
dc.identifier.urihttp://hdl.handle.net/10541/77916-
dc.description.abstractOBJECTIVE: To determine whether choice of colposcopy or six month cytological surveillance would be beneficial to women with mildly abnormal smears when compared with the national policy of six months surveillance in terms of psychological morbidity. DESIGN: A randomised trial based on the Zelen design. SETTING: A hospital-based research clinic. POPULATION: Four hundred and seventy-six women who had had a recurrent borderline or mildly dyskaryotic smear on routine cervical screening in primary care. METHODS: Women were randomised either to six months cytological surveillance or to make a choice between that or colposcopy and were followed up for 1 year. MAIN OUTCOME MEASURES: The primary outcome measure was caseness (score >or=4) on the General Health Questionnaire at 12 months follow up. Other measures were the Spielberger State and Trait scores, default rates and cytology/colposcopy outcomes. RESULTS: There was no significant difference between the arms for General Health Questionnaire (GHQ) scores and Spielberger State and Trait at 12 months. There was a significant reduction in psychometric morbidity between baseline and 12 months in both arms. Overall rates of default from the protocol were the same in both arms, but default that led to uncertain ascertainment of cervical pathology was greater in the no-choice arm. CONCLUSIONS: This trial indicates that having choice did not impact favourably or harmfully on anxiety or feelings of wellbeing. If a patient is anxious, allowing the patient to choose immediate colposcopy may be preferable because it will improve ascertainment of underlying disease in a group who are more likely to default.en
dc.language.isoenen
dc.subjectUterine Cervical Canceren
dc.subject.meshAdult-
dc.subject.meshAnxiety-
dc.subject.meshBiopsy-
dc.subject.meshCervical Intraepithelial Neoplasia-
dc.subject.meshChoice Behavior-
dc.subject.meshColposcopy-
dc.subject.meshFemale-
dc.subject.meshFollow-Up Studies-
dc.subject.meshHumans-
dc.subject.meshInformed Consent-
dc.subject.meshMiddle Aged-
dc.subject.meshPatient Participation-
dc.subject.meshTreatment Outcome-
dc.subject.meshUterine Cervical Neoplasms-
dc.subject.meshVaginal Smears-
dc.titleA randomised controlled trial of cytological surveillance versus patient choice between surveillance and colposcopy in managing mildly abnormal cervical smears.en
dc.typeArticleen
dc.contributor.departmentAcademic Unit of Obstetrics and Gynaecology, St Mary's Hospital, Manchester, UK.en
dc.identifier.journalBJOGen

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