Sawaya George F, Smith-McCune Karen K, Gregorich Steven E, Moghadassi Michelle, Kuppermann Miriam
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA; Center for Healthcare Value, University of California, San Francisco, San Francisco, CA.
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA.
Am J Obstet Gynecol. 2017 Sep;217(3):338.e1-338.e7. doi: 10.1016/j.ajog.2017.05.003. Epub 2017 May 18.
The American College of Physicians strongly recommends against performing pelvic examinations in asymptomatic, nonpregnant women, citing evidence of harm (false-positive testing, unnecessary surgery) and no evidence of benefit. In contrast, the American Congress of Obstetricians and Gynecologists recommends pelvic examinations in asymptomatic women beginning at age 21 years, citing expert opinion.
We sought to evaluate if providing women with professional societies' conflicting statements about pelvic examinations (recommendations and rationales) would influence their desire for a routine examination.
We recruited 452 women ages 21-65 years from 2 women's clinics to participate in a 50-minute face-to-face interview about cervical cancer screening that included a 2-phase study related to pelvic examinations. In the first phase, 262 women were asked about their desire for the examination without being provided information about professional societies' recommendations. In the second phase, 190 women were randomized to review summaries of the American College of Physicians or American Congress of Obstetricians and Gynecologists statement followed by an interview.
First-phase participants served as the referent: 79% (208/262) indicated they would want a routine examination if given a choice. In the second phase, a similar percentage of women randomized to the American Congress of Obstetricians and Gynecologists summary had this desire (82%: 80/97; adjusted odds ratio, 1.37; 95% confidence interval, 0.69-2.70). Women randomized to the American College of Physicians summary, however, were less likely to indicate they would opt for an examination (39%: 36/93; adjusted odds ratio, 0.12; 95% confidence interval, 0.06-0.21). Overall, 94% (179/190) believed the potential benefits and harms should be discussed prior to the examination.
Providing women with a professional society's recommendation advising against routine pelvic examinations substantially reduced their desire to have one. Educational materials are needed to ensure women's informed preferences and values are reflected in decisions about pelvic examinations.
美国医师学会强烈建议不要对无症状的非妊娠女性进行盆腔检查，理由是有危害证据（假阳性检测、不必要的手术）且无益处证据。相比之下，美国妇产科学院建议从21岁起对无症状女性进行盆腔检查，依据的是专家意见。
我们试图评估向女性提供专业学会关于盆腔检查的相互矛盾的声明（建议及理由）是否会影响她们进行常规检查的意愿。
我们从两家女性诊所招募了452名年龄在21至65岁之间的女性，参加一场关于宫颈癌筛查的50分钟面对面访谈，其中包括与盆腔检查相关的两阶段研究。在第一阶段，262名女性被问及她们对检查的意愿，未被告知专业学会的建议。在第二阶段，190名女性被随机分组，阅读美国医师学会或美国妇产科学院声明的摘要，随后进行访谈。
第一阶段参与者作为参照：79%（208/262）表示如果可以选择，她们希望进行常规检查。在第二阶段，随机阅读美国妇产科学院摘要的女性中有类似比例有此意愿（82%：80/97；调整后的优势比为1.37；95%置信区间为0.69 - 2.70）。然而，随机阅读美国医师学会摘要的女性表示她们会选择检查的可能性较小（39%：36/93；调整后的优势比为0.12；95%置信区间为0.06 - 0.21）。总体而言，94%（179/190）的人认为在检查前应讨论潜在的益处和危害。
向女性提供专业学会反对常规盆腔检查的建议会大幅降低她们进行此类检查的意愿。需要教育材料以确保女性的知情偏好和价值观体现在盆腔检查决策中。
