‘I Want the Whole Package’. Elderly Patients’ Preferences for Follow-Up After Abnormal Cervical Test Results: A Qualitative Study
Received 22 April 2020
Accepted for publication 26 June 2020
Published 12 July 2020 Volume 2020:14 Pages 1185—1193
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Johnny Chen
Pia Kirkegaard,1 Line Winther Gustafson,1,2 Lone Kjeld Petersen,3,4 Berit Andersen1,2
1Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark; 2Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; 3Open Patient Data Explorative Network (OPEN), Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark; 4Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
Correspondence: Pia Kirkegaard Email firstname.lastname@example.org
Background: The incidence of cervical cancer peaks around the age of 75 years, and elderly patients are more frequently diagnosed with advanced-stage cervical cancer than younger patients. There is considerable practice variation regarding follow-up of elderly patients with abnormal cervical test results at risk of cervical cancer, both nationally and internationally, due to uncertainty about risks and benefits for this particular patient group. The treatment preferences of these patients are, however, poorly described in the current literature. The aim of this study was to explore elderly patients’ experiences with abnormal cervical test results and preferences for follow-up.
Materials and Methods: We performed focus group interviews with seventeen Danish patients aged 60– 79 years who had undergone biopsy and colposcopy in gynaecological outpatient clinics or at private gynaecologists due to a positive human papillomavirus (HPV) test result and/or abnormal cytology. A focus group interview guide was designed to cover experiences with abnormal cervical test results, including realistic risk and benefit scenarios related to underdiagnosis and overtreatment. Data were analysed thematically using a phenomenological approach.
Results: The patients were surprised that elderly could also have an HPV infection. Most preferred treatment and follow-up at the gynaecologist over continuous control visits at the general practitioner. In case of persistent HPV infection and cervical intraepithelial neoplasia, a quick solution including cone biopsy was preferred even if it carried a risk of overtreatment. The patients wanted clear recommendations and demonstrated considerable intolerance towards healthcare professionals’ clinical uncertainty regarding optimum follow-up.
Conclusion: Most elderly patients wanted closure involving cone biopsy, and they expressed tolerance towards overtreatment to reduce their risk of cervical cancer. Thus, clinicians should present known risks and benefits to elderly patients facing risk of overtreatment after abnormal cervical test results.
Keywords: patient preference, gynaecology: in the elderly, CIN: treatment, qualitative research
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