Khanna N, Phillips M D
Department of Family Medicine, University of Maryland School of Medicine, Baltimore 21201, USA.
J Am Board Fam Pract. 2001 Mar-Apr;14(2):123-30.
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.
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."
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.
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.
宫颈癌是可预防的。根据监测、流行病学和最终结果（SEER）计划，浸润性宫颈癌的发病率为每10万人中有9.0例，癌症死亡率为每10万人中有2.8例。有效的预防措施包括正确使用巴氏涂片检查以及患者遵守护理计划。本综述将探讨不遵守的程度、负面后果、障碍以及为提高护理依从性而采取的干预措施。
1968年至1999年期间，使用关键词“阴道镜检查”、“巴氏涂片异常”、“患者依从性”、“护理依从性”和“随访”在MEDLINE中进行了英文文章的计算机检索。
尽管在所审查的研究中有10%至40%的不依从情况，但不依从的定义并不标准。在不依从的女性中描述了相当高的宫颈癌发病率。随访的最常见障碍是对阴道镜检查目的缺乏了解、对癌症的恐惧、忘记预约以及缺乏时间、金钱或儿童保育。巴氏涂片异常的情绪后果对随访就诊有相当大的影响。针对研究人群的有针对性的干预策略在提高依从性方面最有效。
不依从是由情绪、后勤、文化或社会经济因素相互作用导致的。提高依从性的最有效策略包括由初级医生向患者提供个性化提醒，以及根据医疗机构的规模、结构和风格进行病例管理。
