Holloway Rachel M, Wilkinson Clare, Peters Tim J, Russell Ian, Cohen David, Hale Janine, Rogers Cerilan, Lewis Helen
University of Central Lancashire, Department of Psychology, Harrington Building, Adelphi Street, Preston PR1 2HE.
Br J Gen Pract. 2003 Aug;53(493):620-5.
Women overestimate both population and individual risk of cervical cancer. This may contribute to the recognised excess screening frequency for low-risk women.
To investigate whether an individualized risk communication package could affect stated preferences for screening interval and actual screening behaviour.
Pragmatic, practice-based cluster randomised controlled trial.
Twenty-nine practices (15 intervention, 14 control) in North Wales recruited 1890 women attending for cervical smears.
A risk communication package containing visual material was compared with normal practice. Practice nurses received training in its delivery. The short-term primary outcome was stated preference for screening interval; the long-term primary outcome was actual screening behaviour.
In the short term, intervention arm women were significantly less likely to prefer a shorter than recommended interval (odds ratio [OR] = 0.51, 95% confidence interval [CI] = 0.41 to 0.64; P < 0.0001). At the five-year follow-up, fewer women in the intervention arm had attended for screening sooner than their recommended recall. The magnitude of difference in excess screening interval preference and behaviour was similar, but behaviour had a wider confidence interval and a marginally non-significant P-value (OR = 0.61, 95% CI = 0.36 to 1.03; P = 0.063). Better knowledge and more accurate risk perceptions were demonstrated, with an improvement in measures of anxiety. The extra cost per woman receiving the intervention was 6 Pounds.
Women's perception of risk contributes to determining screening intervals in addition to practice factors. Simple risk information delivered in primary care affected women's stated preferences for tests. The impact on actual screening behaviour was more equivocal. Overall, the intervention showed a substantial benefit and any disbenefit can be ruled out. This approach to providing risk information could, at low cost, benefit other screening programmes and may relieve anxiety.
女性高估了宫颈癌的总体风险和个人风险。这可能导致低风险女性的筛查频率过高，这一现象已得到公认。
研究个性化风险沟通方案是否会影响女性对筛查间隔的既定偏好以及实际筛查行为。
基于实践的务实整群随机对照试验。
北威尔士的29家医疗机构（15家干预组，14家对照组）招募了1890名前来接受宫颈涂片检查的女性。
将包含视觉材料的风险沟通方案与常规做法进行比较。执业护士接受了关于该方案实施的培训。短期主要结局是对筛查间隔的既定偏好；长期主要结局是实际筛查行为。
短期内，干预组女性更倾向于选择短于推荐间隔时间进行筛查的可能性显著降低（优势比[OR]=0.51，95%置信区间[CI]=0.41至0.64；P<0.0001）。在五年随访中，干预组中提前进行筛查的女性少于其推荐召回时间进行筛查的女性。在过度筛查间隔偏好和行为方面的差异幅度相似，但行为的置信区间更宽，P值略无统计学意义（OR=0.61，95%CI=0.36至1.03；P=0.063）。研究显示，女性的知识水平有所提高，风险认知更加准确，焦虑程度也有所改善。接受干预的每位女性的额外成本为6英镑。
除了医疗实践因素外，女性的风险认知也有助于确定筛查间隔。初级保健中提供的简单风险信息影响了女性对检查的既定偏好。对实际筛查行为的影响则更为模糊。总体而言，干预显示出显著益处，且任何不利影响均可排除。这种提供风险信息的方法成本低廉，可能会使其他筛查项目受益，并减轻焦虑。
