Abercrombie P D
Department of Family Health Care Nursing, University of California, San Francisco, USA.
J Obstet Gynecol Neonatal Nurs. 2001 Jan-Feb;30(1):80-8.
To gain a better understanding of factors that affect follow-up and the strategies that have been found to improve follow-up after an abnormal Papanicolaou (Pap) smear test.
A computer-based search of the literature was conducted using MEDLINE with the keywords adherence, nonadherence, compliance, follow-up, and abnormal Pap smears.
Research studies published between 1985 and 1999 in the English language were included. If relevant studies were cited in the articles reviewed, these studies also were reviewed. A total of 25 studies were reviewed.
A critical review of these studies was conducted, with special attention to implications for clinical practice as well as future research. The studies fell into two groups: factors associated with nonadherence and strategies developed to improve adherence.
A number of factors were identified that affect adherence to follow-up among women with abnormal Pap smears. Some of these factors involve characteristics of the woman, such as demographics, social support, lack of understanding, and fear. Factors that pertain to the health care system, such as inconvenient clinic hours, male providers, and insensitive staff, also were identified. A number of strategies have been successful in improving follow-up, including telephone counseling, educational programs, and economic incentives.
Nurses play a crucial role in facilitating adherence to recommendations for follow-up. They can identify women at risk for poor follow-up, increase awareness of the factors that affect follow-up, and implement strategies shown to be successful in improving adherence. Future research should take into account the multifactoral nature of adherence as well as the patient's perspective. In addition, studies should be designed with special attention to generalizability and should include women from populations most at risk for cervical cancer.
更好地了解影响随访的因素以及已发现的改善巴氏涂片检查异常后随访的策略。
使用MEDLINE对文献进行基于计算机的检索，关键词为依从性、不依从性、顺应性、随访和巴氏涂片异常。
纳入1985年至1999年间发表的英文研究。如果在综述文章中引用了相关研究，这些研究也会被综述。共综述了25项研究。
对这些研究进行了批判性综述，特别关注对临床实践和未来研究的影响。这些研究分为两组：与不依从相关的因素和为提高依从性而制定的策略。
确定了一些影响巴氏涂片异常女性随访依从性的因素。其中一些因素涉及女性的特征，如人口统计学、社会支持、缺乏理解和恐惧。还确定了与医疗保健系统相关的因素，如门诊时间不便、男性医护人员和冷漠的工作人员。一些策略在改善随访方面取得了成功，包括电话咨询、教育项目和经济激励措施。
护士在促进对随访建议的依从性方面发挥着关键作用。她们可以识别随访不佳风险较高的女性，提高对影响随访因素的认识，并实施已证明在提高依从性方面成功的策略。未来的研究应考虑依从性的多因素性质以及患者的观点。此外，研究设计应特别关注可推广性，应纳入宫颈癌风险最高人群中的女性。
