Purpose: Management for mildly abnormal Pap smears (HPV triage or repeat Pap testing) has different psychosocial and practical implications for women. We assessed which of 3 different strategies, in which choice was and was not available, resulted in the best psychosocial outcomes over 1 year: clinician directed HPV or Pap testing or women’s informed choice of either test supported by a decision aid.
Method: Women (n=318) with a mildly abnormal Pap smear recruited through women’s health clinics across Australia were randomised to 1 of 3 arms, HPV testing (H), repeat Pap testing (P) or women’s informed choice (IC) of either test supported by a decision aid. Psychosocial outcomes were assessed at multiple time points over 12 months by postal questionnaire.
Result: At 2 weeks after triage, some psychosocial outcomes were worse for women directed to HPV testing compared to those directed to Pap testing (SF36 Vitality subscale: t= -1.63, df=131, P=0.10; intrusive thoughts χ2=8.14, df=1, P<0.01). Over the full year of follow up, distress was lowest among women directed to HPV testing and highest in the Pap testing arm (t= -2.89, df=135, P<0.01). There were few differences between women in the HPV triage and informed choice arm, although knowledge scores were higher compared to both clinician directed arms (mean score IC 8.1 vs H 7.3 vs P 7.2 out of 10, F=4.97, df=2, P<0.01). Intrusive thoughts were also lower in the informed choice arm (IC 13% vs H 25% vs P 17%, difference IC vs H =12%, 95%CI -1.1% to 25.1%). Women in the HPV triage and Informed Choice arms had high levels of satisfaction and were significantly more satisfied than those in the Pap testing arm. We compared informed choice versus clinician directed management (HPV and Pap combined). There was weak evidence in favor of choice for the SF36 mental component score (2.5, 95%CI -0.2 to 5.3, P=0.07) and the subscales vitality, social function and mental health.
Conclusion: Over the full year of follow-up, clinician directed HPV triage is better for women’s psychosocial health compared to repeat Pap testing. There is some indication that offering informed choice provides some benefit to women with respect to quality of life, improved knowledge and intrusive thoughts.
Candidate for the Lee B. Lusted Student Prize Competition