宫颈发育不良诊断对个体癌症预防习惯随时间推移的影响：一项双中心病例对照研究。
The impact of a cervical dysplasia diagnosis on individual cancer prevention habits over time: a bicentric case-control study.
机构信息
Department of Gynaecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
Institute of Medical Biometry and Informatics (IMBI), University Hospital Heidelberg, Heidelberg, Germany.
出版信息
Arch Gynecol Obstet. 2019 Mar;299(3):847-855. doi: 10.1007/s00404-018-5029-5. Epub 2019 Jan 4.
PURPOSE
Annual cervical cancer screening is recommended in Germany as a part of the statutory preventive care. Abnormal results can provoke psychological distress and anxiety, compromising women's adherence. Little is known about how a cervical dysplasia impacts adherence follow-up visits and prevention habits over time. To optimize care strategies, this study aims to identify women at risk for nonadherence to follow-up visits after a screening event.
METHODS
Between November 2015 and May 2017, participants with an abnormal Pap smear at the Heidelberg and Leipzig University Hospitals received a four-part questionnaire (sociodemographic data, PHQ-D, self-designed fear and prevention habit questions) at the first consultation (T1) and subsequently after 3 (T2) and 6 (T3) months; healthy controls completed the questionnaire at T1.
RESULTS
132 women with an abnormal Pap smear [with conization: S1 (n = 68, 51.5%), without intervention: S2 (n = 64, 48.5%)] and healthy controls (K, n = 101) generally adhered to gynecological checkups, except S1 6 months after the first diagnosis (S1/T3 - 0.47, signed rank p < 0.0005). Knowledge of primary prevention information, i.e., HPV vaccination, was significantly higher among K (K 58%, S1 29%, S2 44%, Chi-squared p = 0.01) as was vaccine uptake (K 39% versus S1/S2 7% and 17%, respectively, Chi-squared p = 0.0004). Fear of upcoming Pap smears rose significantly over time (S1/T1-S1/T2-S1/T3, Wilcoxon signed-rank test p < 0.001) and was higher among those with conization at T2 (Chi-square test, p = 0.01) and partially accompanied by panic disorders at T1 (Chi-square test p = 0.035). Realization of general preventive habits rose significantly among women without an operative procedure (S2) over the study.
CONCLUSION
This study advances the understanding of non-participation in follow-up visits after a dysplasia diagnosis, identifying post-conization women as a special risk group for decreased adherence.
目的
德国建议将每年的宫颈癌筛查作为法定预防保健的一部分。异常结果可能会引起心理困扰和焦虑，从而影响女性的依从性。对于宫颈发育不良如何影响随时间推移的随访就诊和预防习惯，人们知之甚少。为了优化护理策略，本研究旨在确定在筛查事件后随访就诊依从性差的女性。
方法
2015 年 11 月至 2017 年 5 月，海德堡和莱比锡大学医院接受异常巴氏涂片检查的参与者在第一次就诊时（T1）接受了四部分问卷（社会人口统计学数据、PHQ-D、自行设计的恐惧和预防习惯问题），随后在 3 个月（T2）和 6 个月（T3）后进行；健康对照组在 T1 时完成问卷。
结果
132 名巴氏涂片异常的女性（行锥切术：S1（n=68，51.5%），未行干预：S2（n=64，48.5%））和健康对照组（K，n=101）通常都接受了妇科检查，除了 S1 在第一次诊断后 6 个月（S1/T3-0.47，符号秩检验 p<0.0005）。K 组对初级预防信息（即 HPV 疫苗接种）的了解明显高于 S1 组（K 组 58%，S1 组 29%，S2 组 44%，卡方检验 p=0.01），疫苗接种率也高于 S1/S2 组（K 组 39%，S1/S2 组分别为 7%和 17%，卡方检验 p=0.0004）。对即将进行的巴氏涂片检查的恐惧随时间显著增加（S1/T1-S1/T2-S1/T3，Wilcoxon 符号秩检验 p<0.001），并且在 T2 时行锥切术的女性中更高（卡方检验，p=0.01），并且在 T1 时部分伴有惊恐障碍（卡方检验 p=0.035）。未行手术的女性（S2）在研究期间预防习惯的意识显著提高。
结论
本研究深入了解了宫颈发育不良诊断后不参与随访就诊的情况，确定了锥切术后女性是依从性下降的特殊高危人群。
Zotero 插件