Cervical cancer. 2: Colposcopy, treatment and patient education

In the first article in this two-part series (Vol 8(11): 730-34) the issue of cervical screening and the cervical smear test was described and discussed. This article looks at colposcopy. When a woman receives an abnormal smear test result, she will often require further examination of the cervix in order to identify the degree and area of dyskaryosis. Colposcopy can often provoke feelings of fear and anxiety in women and the nurse must help to alleviate these fears and anxieties. Colposcopy and cervical intraepithelial neoplasia are discussed and the treatment (if any) is outlined.     

Speculum 'self-insertion': a pilot study

Aim. This paper reports phase II of a pilot study that aimed to determine whether self‐insertion of a speculum by women undergoing a pap smear would be more comfortable and lead to an improvement in satisfaction and a decrease in anxiety associated with this procedure. Background. Research demonstrates that pelvic examinations are considered by most women to be unpleasant and are routinely associated with embarrassment, apprehension, fear and often some level of discomfort and/or pain. Design. The study used quantitative and qualitative data collection techniques. Phase I (described elsewhere) tested the newly developed Speculum Self‐Insertion Satisfaction Questionnaire for content validity, internal consistency and clarity. Phase II pilot study tested the technique of speculum self‐insertion. Women's general level of anxiety was measured using the State Trait Anxiety Inventory, both before and after they performed the self‐insertion procedure. Women's satisfaction and acceptance of the procedure was measured using the Speculum Self‐Insertion Satisfaction Questionnaire and explored through the use of qualitative research techniques. Participants. A total of 198 women attending family planning clinics in Perth, Western Australia, between September and December 2003 were invited to participate in the study. One hundred and thirty‐three women agreed to self‐insert their own speculum. Results. The study demonstrated that speculum self‐insertion was acceptable to most women, especially younger women. Nearly 91% of women either agreed or strongly agreed that they were satisfied with the experience of self‐insertion and would choose to self‐insert the speculum again. This included the women who had not previously had a speculum examination. The quality of specimen collected was not detrimentally affected by speculum self‐insertion. Conclusions. The results of this pilot research, while needing to be replicated in a larger study, demonstrate that offering women the opportunity to self‐insert a speculum during a routine pelvic examination is an acceptable, innovative, simple and cost‐neutral change in clinical practice that increases women's comfort and satisfaction and potentially makes sexual health screening less threatening to women of all ages. Relevance to clinical practice. Speculum self‐insertion may encourage women's attendance at clinics for regular screening. Early diagnosis and treatment will result in better health outcomes for women, families and the community at large.     

Lived experience of Thai women and their changing bodies in midlife

This study focused on the lived experience of Thai women and their changing bodies in midlife. The methodology chosen was a phenomenological approach. Eighteen women aged 46–55 years, who lived in the southern Thailand and identified themselves as experiencing physiological changes, participated in the study. Five themes became apparent during the analysis of the women's stories: changing in midlife, sensing normal phenomena, searching for explanation, sense of loss, and self‐managing. This study reveals that Thai women's traditional ties to Buddhism play a major role in their acceptance of midlife as part of the life cycle; an event that is best managed with support from other women. Health professionals should reconsider their understanding of women's midlife experiences in order to provide effective healthcare support to Thai women.     

New mothers' experiences of social disruption and isolation during the severe acute respiratory syndrome outbreak in Hong Kong

In Hong Kong during the severe acute respiratory syndrome outbreak of 2003, sustained uncertainty caused daily stress for residents for > 3 months. Expectant women experienced unexpected social disruption and isolation within their day‐to‐day life that have not been described in their own voice. The purpose of this study was to describe the experiences of women who became mothers during the outbreak and the ways in which these experiences impacted their early post‐partum mothering. A phenomenological research design was chosen. The participants' responses then led the interview process. As the women's experiences had many similarities, saturation was reached after eight interviews. Four themes emerged: living with uncertainty, intense vigilance, isolation, and disrupted expectations. The participants spoke of disrupted daily routines as they tried to eliminate their risk of contracting this disease, including relationship difficulties with their spouse. None of the women had the birth experience they had hoped for because of changes in hospital practices.     

WOMEN'S MIDLIFE CONFUSION: "WHY AM I FEELING THIS WAY?"

Midlife is a multifaceted stage of woman's development, characterized by important transitions. In an ethnographic study of women's midlife experience of their changing bodies, 11 participants voiced their uncertainty and confusion around bodily changes, responses exacerbated by the lack of consistent health-related information in this area. This confusion emerged as one of the major thematic elements of the study. Midlife women's experience of confusion may reflect a much broader problem, the locus of which is not so much in the women themselves, but rather in negative societal attitudes about aging women. This article describes various aspects of confusion that emerged from the data, and offers implications of the research and recommendations for practitioners.     

The colposcopy experience: what do women know?

A study of 149 first-time colposcopy women was undertaken to determine their level of knowledge about female anatomy, abnormal pap results, and the colposcopy procedure. Factors which influenced their knowledge were also explored. Results suggest that women are missing fundamental knowledge about the experience; for example, location of the cervix (39.6%), site of pap smear (44.3%), meaning of pap result (38.9%), and the purpose of colposcopy (32.4%). Older women with a university education knew more. Women's perception of information gained through personal contacts and this information combined with that obtained through written material had a significant impact on what they knew. Women identified the type, source and preferred timing of additional information that would be helpful. The data provide valuable insights for nurses who practise in ambulatory settings and doctors' offices.     

液基薄层细胞检测系统与阴道镜下活检在诊断子宫颈病变中的价值

目的 探讨液基薄层细胞检测系统（TCT）宫颈细胞涂片及阴道镜下宫颈活检对宫颈上皮内瘤变（CIN）的诊断价值。方法 回顾性分析哈尔滨医科大学附属肿瘤医院4041例TCT筛查结果及其中308例细胞学阳性行阴道镜下活检的病理结果。结果 鳞状上皮内低度病变（LSIL）及鳞状上皮内高度病变（HSIL）的诊断，细胞学检查诊断率高于阴道镜下活检病理学检查。炎症及鳞状细胞癌（SCC）的诊断，阴道镜下活检病理学检查诊断率高于细胞学检查。结论 采用TCT筛查可早期发现宫颈病变；细胞学阳性或临床可疑者应配合阴道镜捡查及镜下活检可提高CIN的检出率；对TCT呈意义不明确的非典型鳞状细胞（ASC-US）和不除外高度上皮内瘤变的非典型鳞状细胞（ASC-H）的患者进行阴道镜下活检可降低漏诊率。     

Women's experiences of making healthcare decisions about their breast cancer: A phenomenological study

There are few studies about how healthcare decisions are made for women with breast cancer in China and this knowledge is vital, both to further develop person‐centered health care and to ensure that women have a voice in their healthcare decisions. This phenomenological study explored the meaning of women's lived experiences of making healthcare decisions about their breast cancer in China. Semistructured, in‐depth interviews were conducted with a purposive sample of eight women with breast cancer. Data were analyzed using Colaizzi's phenomenological analytic method. The results of this study identified four themes: authority and expertise, lack of knowledge, family support, and Chinese cultural and social influences. Women were deferential to medical authority and perceived expertise, but they wanted to be involved to a greater degree in healthcare decisions. It is important for health professionals to optimize women's participation in decision‐making by removing barriers and advocating on their behalf.     

Effectiveness of nursing interventions to increase pap smear test screening

The purpose of this study was to determine the effect of a three‐stage nursing intervention to increase Turkish women's participation in Pap smear testing. Knowledge and beliefs about cervical cancer screening and barriers to Pap smears also were explored. In a quasi‐experimental study in a target population of 2,500 women, 237 completed pre‐test measures to inform the intervention, and an educational brochure was distributed to all 2,500. As a result, 510 women (20.4%) accepted free Pap smears. Of the remaining 1,990 women, 417 were randomly selected for telephone interviews, 302 participated, and 158 of these (52.3%) participated in free Pap smear testing. Of the 144 who did not have Pap smears after participating in telephone interviews, 54 were then interviewed face‐to‐face, and 20 (37.0%) decided to accept free Pap smears. A total of 668 women had accepted free Pap smears by the end of the intervention period. © 2013 Wiley Periodicals, Inc. Res Nurs Health 36:146–157, 2013     

Interactive model of client health behavior and cervical cancer screening of African-American women

ABSTRACT Objective: Explore inductively African American women's use of Pap smear screening services and consider how well the data did or did not affirm the usefulness of the interaction model of client health behavior (IMCHB). Design and Sample: The IMCHB guided this qualitative study designed to explore women's social influence and previous health care experience and their influence on the women's cognitive appraisal associated with Pap smears and cervical cancer. Interviews were conducted with 24 women, resulting in 2 groups: routine‐use (n=11) (Pap smears every 1–3 years) and non‐routine‐use (n=13). Measures: Content analysis approach to data analysis was used, where interview data were considered in relation to elements of IMCHB. Results: Analysis revealed that the IMCHB was useful for framing cervical cancer screening health behavior research. Both groups' data fit well onto the framework. The routine‐use group fit the entire model, with iterative (repeat) behavior in cervical cancer screening. The non‐routine‐use group also fit the model, but their iterative behavior in cervical cancer screening was intermittent due to negative personal influences. Conclusions: This model can provide a focus to the delivery of gynecological care based on a client's unique characteristics that can be addressed with individualized nursing interventions designed to promote positive health outcomes.     

The feeling of being trapped in and ashamed of one's own body: A qualitative study of women who suffer from eating difficulties

The aim of this study was to explore women's bodily experiences of suffering from eating difficulties (ED). The research question was: How do women who suffer from ED experience the bodily aspects related to their condition? Women suffering from ED experience problems in both the physical and emotional areas. Few qualitative studies have specifically addressed sufferers' bodily experiences related to ED. An explorative design was used. The data were collected by means of focus group interviews on the subject of ED‐related problems, guilt and shame, and being a mother. The interpretation of the qualitative data was inspired by hermeneutic content analysis. The main theme, ‘Powerful feelings of being trapped in and ashamed of one's own body’, comprised two themes: ‘The feeling of being trapped by overwhelming physical sensations’ and ‘The feeling of being ashamed of one's own body’. Bodily experiences were reported as strong. One clinical implication for nurses is to acknowledge this fact and make it possible for these women to articulate their difficulties, especially those connected to the feelings of being trapped and ashamed. Support groups focusing on these themes could be one way of assisting women and easing some of the negative feelings associated with ED.     

Understanding Factors Related to Women's Adherence to Colposcopy

Early detection can prevent death from cervical cancer, but success is dependent on women with abnormal cytology attending follow-up procedures, including colposcopy. Factors that influence adherence to colposcopy include age, race, education, socioeconomic status, smoking, chemical dependence, intimate partner violence and anxiety. Comprehension of abnormal Pap smear results and knowledge of current treatment guidelines and follow-up is important in the prevention of cervical cancer. Understanding factors that could inhibit adherence to colposcopy will allow for tailored communication and individualized treatment to prevent colposcopy default. Implementation of colposcopy clinics with designated nurses to track and monitor adherence could help.     

APN Knowledge,Self‐Efficacy,and Practices in Providing Women's Healthcare Services to Women with Disabilities

Women with disabilities require the same gynecological and reproductive healthcare services as women without disabilities, yet they often experience difficulty obtaining them. Advanced practice nurses (APNs) increasingly provide primary care services that include women's health care, yet their influence on this population has not been systematically examined. This study examined the practices, environments, knowledge, and self‐efficacy of APNs in Texas regarding provision of women's health care to women with disabilities. The study's respondents are 744 women who replied to a mailed survey. The results reveal that while nurses do not lack knowledge, work environments do not support competent care of women with disabilities and practices do not always follow national guidelines. Predictors of self‐efficacy in provision of health care to women with disabilities were status as a women's health nurse practitioner, previous rehabilitation experience, high knowledge scores, and a working environment perceived as accessible. Until changes are made in APN education and environmental barriers are addressed, APNs may not be able to provide optimal women's healthcare services to women with disabilities.     

A kind reminder—A qualitative process evaluation of women's perspectives on receiving a reminder of type 2 diabetes follow-up screening after gestational diabetes

Rationale, Aims and Objectives

Women with previous gestational diabetes mellitus (GDM) are more than eight times more likely to develop type 2 diabetes (T2DM) compared to women without GDM. Annual follow-up T2DM-screening is recommended, but participation rates decrease rapidly after the first year. In the North Denmark Region, an electronic reminder has been tested with the aim of improving follow-up care for women with prior GDM. The aim of this study was to explore women's perspectives on receiving an electronic reminder, and the role of reminders in both women's decision-making and informed choice regarding participation in follow-up screening.

Methods

A qualitative process evaluation informed by a critical realistic perspective. Data consisted of 20 semi-structured interviews with women previously diagnosed with GDM who had received the reminder. Interviews were analyzed using reflexive thematic analysis.

Results

The reminder affected women's decision-making and informed choices through a range of mechanisms. Its personalized design prompted feelings of co-responsibility and care from the healthcare system, supported continuity in women's care pathways, and helped women bridge the gap between healthcare sectors. Women's perception of diabetes risk and the importance of follow-up influenced their decision-making. Participation in follow-up screening was influenced by several contextual factors, as women's everyday life impeded their prioritizing follow-up screening. Women who experienced being met by their general practitioner (GP) with acknowledgement rather than stigmatization and received supportive information tailored to their life situation were more motivated to participate in future follow-up screenings.

Conclusion

The reminder indicated both concern and co-responsibility for women's follow-up care after GDM and was well received by the women. It supported participation in follow-up screening through an emphasis on shared decision-making and informed choice. Women's interaction with their GP played a significant role.     

The meaning of women's experience of living with long-term urinary incontinence is powerlessness

Aim. The aim was to illuminate the meaning of women's experiences of living with urinary incontinence (UI). Background. Living with long‐term UI means a variety of consequences for everyday life. Women's narratives about their lived experiences are important in enabling nurses to better understand and to help women achieve symptom control. No previous study could be found that has focused on the meaning of women's experience of living with UI from a symptom management perspective. Method. Fourteen women with UI (range: 34–52 years) who had sought professional help were interviewed. A phenomenological hermeneutic method was used to analyse and interpret the interview texts. Findings. The women's experiences of living with UI are presented in terms of two interlaced themes of being in a vulnerable situation and striving for adjustment. Being in a vulnerable situation means that the women had no control over UI and experienced powerlessness. The sub‐themes in this case were living with an uncontrolled body, living with incontinence as taboo and experiencing a less satisfying encounter. Striving for adjustment means that the women tried to handle their incontinence in different ways to regain power and continue to live as normal. The sub‐themes here were living in readiness, making urine leakage comprehensible, accepting living with UI and being familiar with the situation. Conclusion. The meaning of women's experience of living with UI is powerlessness. Relevance to clinical practice. Nurses should supervise women in pelvic floor muscle training to achieve control over incontinence, thereby helping them regain power. Additionally, Integrated Approach to Symptom Management can help nurses enhance women's self‐care abilities.     

Factors affecting the compliance of Israeli women with screening for intimate partner violence

Violence against women has become a frequent occurrence. In Israel, some 200 000 women are subjected to various types of violence by their intimate partners annually. Routine screening for intimate partner violence is endorsed by the Ministry of Health in Israel; however, screening rates in health‐care settings remain problematic. This study aimed to examine whether the model based on the Theory of Reasoned Action (TRA) succeeds in predicting women's intention to comply with screening for intimate partner violence. A questionnaire based on the literature review and research model was administered to a convenience sample of 200 married women. Although only 4.5% (n = 9) of respondents were screened for violence at various health‐care institutions over the past year, 75% (n = 150) of women declared that they intend to cooperate with screening. A positive correlation was found between women's marriage duration, beliefs concerning violence, attitudes towards screening, family member support for compliance with screening—and women's intention to comply with screening. The TRA succeeds in partially predicting women's intention to comply with screening.     

10349例已婚妇女妇科普查结果分析

目的:了解中国妇女妇科健康状况,探索科学的妇科普查方法.方法:回顾分析2009年11月-2010年10月在复旦大学附属妇产科医院体检中心进行妇科普查的10 349例已婚妇女的常规体格检查、盆腔B超检查、白带常规检查、宫颈细胞学检查(包括巴氏涂片法或新柏氏TCT法)等资料.部分妇女进行高危型人乳头状瘤病毒(HR-HPV)检测,HR-HPV阳性或TCT异常者进行阴道镜病理组织学检查.结果:10 349例体检妇女中发现慢性宫颈炎2 100例,患病率为21.8％;子宫肌瘤1371例,患病率为14.2％;乳腺病878例,患病率为8.5％;阴道炎420例,患病率为4.1％.在296例HR-HPV阳性或TCT异常者中发现宫颈上皮内瘤变56例,早期宫颈浸润癌4例.TCT异常组的宫颈上皮内瘤变发生率显著高于HR-HPV阳性组的上皮内瘤变发生率.结论:妇科普查能及时发现妇科常见病,TCT和HR-HPV联合检查有助于宫颈上皮内瘤变的早期诊断.     

阴道镜及宫颈细胞学筛查在子宫颈病变诊断中的应用及护理

目的探讨阴道镜检查和宫颈细胞学筛查在子宫颈病变中的临床诊断价值及护理。方法回顾性分析2003年1月至2005年12月本院门诊641例宫颈病变患者的阴道镜检查和宫颈细胞学筛查结果。结果641例宫颈病变患者均行阴道镜检查和宫颈细胞学筛查。病理诊断为宫颈不典型增生（CIN）Ⅰ级58例,Ⅱ级82例,Ⅲ级95例,宫颈原位癌10例,宫颈早期浸润癌3例,宫颈慢性炎404例。系统宣教以后患者对宫颈病变的认知度提高32％。结论阴道镜检查和宫颈细胞学筛查对早期发现宫颈癌、宫颈癌前病变有重要价值,系统的护理可以提高患者对宫颈病变的认知度。     

宫颈刮片、阴道镜及HPV检测在诊断宫颈癌和癌前病变中的应用

目的:评价宫颈刮片、阴道镜及高危HPV检测在宫颈癌及癌前病变诊断中的效果。方法:对发现宫颈异常的患者同时进行宫颈刮片、阴道镜检查及高危HPV检测,对一项或多项异常者行病理组织学检查,并以病理结果为金标准。对134例病理结果阳性(CIN Ⅰ、CINⅡ、CINⅢ、宫颈浸润癌)的患者,比较三种方法的检出敏感度。结果:宫颈刮片阳性者70例,敏感度为52.2%,阴道镜108例,敏感度为80.6%,两者阳性检出率相比有极显著差异(P<0.01)。高危HPV感染者阳性118例, 敏感度88.1%,与宫颈刮片的敏感度相比有极显著差异(P<0.01),与阴道镜的敏感度相比,有显著差异(P<0.05)结论:对于宫颈癌及其癌前病变的筛查及早期诊断,应以宫颈细胞学检查和阴道镜检查及高危HPV检测相互结合以提高检出率,降低假阴性。