Norrell Laura L, Kuppermann Miriam, Moghadassi Michelle N, Sawaya George F
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California at San Francisco, San Francisco, CA.
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California at San Francisco, San Francisco, CA.
Am J Obstet Gynecol. 2017 Jul;217(1):86.e1-86.e6. doi: 10.1016/j.ajog.2016.12.031. Epub 2016 Dec 28.
The American Congress of Obstetricians and Gynecologists recommends that a pelvic examination be offered to asymptomatic women after an informed discussion with their provider. Although the adverse health outcomes that the examination averts were not delineated, the organization stated that it helps establish open communication between patients and physicians. Recent surveys have focused on obstetrician-gynecologists' attitudes and beliefs about the examination, but the perspectives of women have not been well-characterized.
The purpose of this study was to better understand women's beliefs about the purpose and value of routine pelvic examinations.
We completed structured interviews with 262 women who were 21-65 years old who agreed to participate in a 50-minute interview about cervical cancer screening. Recruitment took place in outpatient women's clinics at a public hospital and an academic medical center in San Francisco, CA. Women were shown an illustration of a bimanual pelvic examination and asked a series of closed-ended questions: if they knew why it was performed, if it reassured them of their health, and if they believed it helped establish open communication with their provider. Women were asked an open-ended question about their perception of the examination's purpose. Multivariable logistic regression analysis was used to identify demographic predictors of responses.
Approximately one-half of the participants (56%) stated that they knew the examination's purpose. The most frequently cited reason was assurance of normalcy. Most of participants (82%) believed that the examination reassured them of their health. Approximately two-thirds of the participants (62%) believed that the examination helps establish open communication with their provider. In multivariate analyses, older age (≥45 years) independently predicted a higher likelihood of a belief that they knew the examination's purpose (odds ratio, 2.9; 95% confidence interval, 1.5-5.6) and a belief that it facilitates open communication (odds ratio, 2.1; 95% confidence interval, 1.1-3.9). Non-white race also was associated with a belief that the examination helps facilitate open communication between patients and providers (odds ratio, 1.9; 95% confidence interval, 1.1-3.1).
Approximately one-half of the women who participated in our study reported not knowing the purpose of the pelvic examination, yet most of them believed it to be of some value, especially reassurance of health. To achieve shared, informed decision-making, clinicians will need to communicate better to their patients the examination's purpose.
美国妇产科医师学会建议，在与医疗服务提供者进行充分沟通后，应对无症状女性进行盆腔检查。尽管该检查可避免的不良健康后果未作明确说明，但该组织表示，它有助于在患者和医生之间建立开放的沟通渠道。最近的调查主要关注妇产科医生对该检查的态度和看法，但女性的观点尚未得到充分描述。
本研究旨在更好地了解女性对常规盆腔检查目的和价值的看法。
我们对262名年龄在21至65岁之间的女性进行了结构化访谈，她们同意参加一场关于宫颈癌筛查的50分钟访谈。招募工作在加利福尼亚州旧金山一家公立医院和一家学术医疗中心的门诊妇科诊所进行。向女性展示了双合诊盆腔检查的示意图，并询问了一系列封闭式问题：她们是否知道进行该检查的原因，是否通过该检查对自身健康放心，以及是否认为该检查有助于与医疗服务提供者建立开放的沟通。还向女性询问了一个关于她们对该检查目的看法的开放式问题。采用多变量逻辑回归分析来确定回答的人口统计学预测因素。
约一半的参与者（56%）表示知道该检查的目的。最常提及的原因是确认身体正常。大多数参与者（82%）认为该检查让她们对自己的健康放心。约三分之二的参与者（62%）认为该检查有助于与医疗服务提供者建立开放的沟通。在多变量分析中，年龄较大（≥45岁）独立预测了她们更有可能认为自己知道该检查的目的（优势比为2.9；95%置信区间为1.5 - 5.6），以及更有可能认为该检查有助于建立开放的沟通（优势比为2.1；95%置信区间为1.1 - 3.9）。非白人种族也与认为该检查有助于促进患者与医疗服务提供者之间开放沟通的看法相关（优势比为1.9；95%置信区间为1.1 - 3.1）。
参与我们研究的女性中约有一半表示不知道盆腔检查的目的，但她们中的大多数人认为该检查有一定价值，尤其是能让人对健康放心。为了实现共同的、基于充分信息的决策，临床医生需要更好地向患者传达该检查的目的。
