Ferris D G, Kriegel D, Cote L, Litaker M, Woodward L
Medical Effectiveness Education and Research Program, Medical College of Georgia, Augusta, USA.
Arch Fam Med. 1997 Jul-Aug;6(4):348-53. doi: 10.1001/archfami.6.4.348.
To determine women's triage test preferences for the evaluation and management of atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL) Papanicolaou smear reports.
A 35-item questionnaire.
Primary care clinic waiting rooms.
A convenience sample of 968 women.
Women received standardized descriptions of the meaning of ASCUS and LSIL Papanicolaou smear classifications and uniform descriptions of the 4 triage tests: Papanicolaou smear, human papillomavirus DNA test, cervicography, and colposcopy.
Subjects' responses to questionnaire.
More women (58.4%) preferred a repeat Papanicolaou smear for an ASCUS report than would choose human papillomavirus DNA testing (7.3%), cervicography (20.6%), or colposcopy (13.8%) (P < .001, chi 2). Alternatively, 51% of women wanted colposcopy to evaluate an LSIL report compared with the other 3 options (P < .001, chi 2). Test accuracy was the most important factor that influenced women's decisions for each test, compared with cost, discomfort, and other reasons (P < .001, chi 2). Positive predictors for women's selection of colposcopy to evaluate a Papanicolaou smear showing LSIL included older age (P < .01, logistic regression analysis), higher level of income (P < .001, chi 2), greater level of education (P < .001, logistic regression analysis), greater level of knowledge of colposcopy and Papanicolaou smears (P < .001, logistic regression analysis), family history of cervical cancer (P < .01, chi 2), and history of cervical dysplasia (P = .02, chi 2).
Most women preferred a repeat Papanicolaou smear to further evaluate an initial Papanicolaou smear demonstrating ASCUS and colposcopy to evaluate a report of LSIL. Women identified test accuracy as the most important reason for triage test selection. Multiple factors, primarily involving patient and family history of cervical neoplasia, level of education, income, age, and knowledge of tests, influence women's desire for specific triage tests. Because no optimal management of women with ASCUS and LSIL Papanicolaou smear reports has been determined, consideration of women's triage test preferences should complement overall patient care.
确定女性对于用于评估和管理意义不明确的非典型鳞状细胞（ASCUS）和低级别鳞状上皮内病变（LSIL）巴氏涂片报告的分流检测的偏好。
一份包含35个条目的问卷。
初级保健诊所候诊室。
968名女性的便利样本。
向女性提供ASCUS和LSIL巴氏涂片分类含义的标准化描述，以及4种分流检测的统一描述：巴氏涂片、人乳头瘤病毒DNA检测、宫颈造影和阴道镜检查。
受试者对问卷的回答。
对于ASCUS报告，更多女性（58.4%）更倾向于重复巴氏涂片，而非人乳头瘤病毒DNA检测（7.3%）、宫颈造影（20.6%）或阴道镜检查（13.8%）（P <.001，卡方检验）。另外，对于LSIL报告，51%的女性希望进行阴道镜检查，相比其他3种选择（P <.001，卡方检验）。与成本、不适及其他原因相比，检测准确性是影响女性对每种检测决策的最重要因素（P <.001，卡方检验）。女性选择阴道镜检查来评估显示LSIL的巴氏涂片的阳性预测因素包括年龄较大（P <.01，逻辑回归分析）、收入水平较高（P <.001，卡方检验）、教育程度较高（P <.001，逻辑回归分析）、对阴道镜检查和巴氏涂片的了解程度较高（P <.001，逻辑回归分析）、宫颈癌家族史（P <.01，卡方检验）以及宫颈发育异常史（P =.02，卡方检验）。
大多数女性更倾向于重复巴氏涂片以进一步评估初次显示ASCUS的巴氏涂片，以及进行阴道镜检查以评估LSIL报告。女性将检测准确性确定为选择分流检测的最重要原因。多种因素，主要涉及患者及其宫颈癌家族史、教育程度、收入、年龄和检测知识，会影响女性对特定分流检测的需求。由于尚未确定对ASCUS和LSIL巴氏涂片报告女性的最佳管理方法，考虑女性的分流检测偏好应作为整体患者护理的补充。
