Hendry Maggie, Pasterfield Diana, Gollins Simon, Adams Richard, Evans Mererid, Fiander Alison, Robling Michael, Campbell Christine, Bekkers Marie-Jet, Hiscock Julia, Nafees Sadia, Rose Janice, Stanley Margaret, Williams Olwen, Makin Matthew, Wilkinson Clare
North Wales Centre for Primary Care Research, Bangor University, Bangor, UK.
North Wales Cancer Treatment Centre, Betsi Cadwaladr University Health Board, Rhyl, UK.
BMJ Open. 2017 Jun 26;7(6):e015413. doi: 10.1136/bmjopen-2016-015413.
High-risk human papillomaviruses (HPVs) cause all cervical cancer and the majority of vulvar, vaginal, anal, penile and oropharyngeal cancers. Although HPV is the most common sexually transmitted infection, public awareness of this is poor. In addition, many clinicians lack adequate knowledge or confidence to discuss sexual transmission and related sensitive issues. Complex science needs to be communicated in a clear, digestible, honest and salient way. Therefore, the aim of this study was to coproduce with patients who have cancer appropriate resources to guide these highly sensitive and difficult consultations.
A matrix of evidence developed from a variety of sources, including a systematic review and telephone interviews with clinicians, supported the production of a draft list of approximately 100 potential educational messages. These were refined in face-to-face patient interviews using card-sorting techniques, and tested in cognitive debrief interviews to produce a ‘fast and frugal’ knowledge tool.
We developed three versions of a consultation guide, each comprising a clinician guidance sheet and patient information leaflet for gynaecological (cervical, vaginal, vulvar), anal or oropharyngeal cancers. That cancer could be caused by a sexually transmitted virus acquired many years previously was surprising to many and shocking to a few patients. However, they found the information clear, helpful and reassuring. Clinicians acknowledged a lack of confidence in explaining HPV, welcomed the clinician guidance sheets and considered printed information for patients particularly useful.
Because of the ‘shock factor’, clinicians will need to approach the discussion of HPV with sensitivity and take individual needs and preferences into account, but we provide a novel, rigorously developed and tested resource which should have broad applicability in the UK National Health Service and other health systems.
高危型人乳头瘤病毒（HPV）引发了所有的宫颈癌以及大多数外阴癌、阴道癌、肛门癌、阴茎癌和口咽癌。尽管HPV是最常见的性传播感染，但公众对此的认知却很差。此外，许多临床医生缺乏足够的知识或信心来讨论性传播及相关敏感问题。复杂的科学知识需要以清晰、易懂、诚实且突出重点的方式进行传达。因此，本研究的目的是与癌症患者共同制作合适的资源，以指导这些高度敏感且困难的咨询。
通过多种来源（包括系统综述以及对临床医生的电话访谈）形成的证据矩阵，支持了一份约100条潜在教育信息清单初稿的编制。这些信息在面对面的患者访谈中使用卡片分类技术进行完善，并在认知反馈访谈中进行测试，以制作一个“快速且简便”的知识工具。
我们开发了三个版本的咨询指南，每个版本都包括一份临床医生指导手册和针对妇科（宫颈癌、阴道癌、外阴癌）、肛门癌或口咽癌的患者信息传单。许多患者对癌症可能由多年前获得的性传播病毒引起感到惊讶，少数患者感到震惊。然而，他们觉得这些信息清晰、有用且令人安心。临床医生承认在解释HPV方面缺乏信心，对临床医生指导手册表示欢迎，并认为给患者的印刷信息特别有用。
由于存在“冲击因素”，临床医生在讨论HPV时需要敏感对待，并考虑个体需求和偏好，但我们提供了一种新颖、经过严格开发和测试的资源，该资源在英国国民医疗服务体系及其他卫生系统中应具有广泛的适用性。
