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Women's understanding of abnormal cervical smear test results: a qualitative interview study

Abstract Objective: To describe how women interpret their experiences of diagnosis and treatment of a cervical abnormality and how healthcare services for such women can be improved. Design: Qualitative study using detailed individual interviews. Setting: Australian gynaecology clinics. Subjects: 29 Women who had a cervical cytological abnormality and who attended a gynaecologist. Main outcome measures: Women's views on their diagnosis and their information needs. Results: Most women wanted to participate in decisions about their care but found it difficult to get the information they required from doctors because they were confused by what their doctors told them and felt unable to ask questions in the consultation. Medical terms such as wart virus and precancer were difficult to understand. Not being able to see their cervix also made it hard for women to understand what their abnormality meant and what treatment entailed. Most women tried to make sense of their abnormality in the context of their everyday lives. For some women their gynaecological care was not consistent with the way they understood their abnormality. Conclusions: The inherent power structure of medical practice combined with time pressures often make it difficult for doctors to give the detailed information and reassurance patients need when a diagnosis is distressing or when investigation and treatment are strange and upsetting. Key messages Women who have abnormalities detected on cervical smears are confused, afraid, and find it difficult to get the information they require In this study women often assumed that they had cancer because they did not know that smear tests detected precancerous lesions Women needed information about the seriousness of their abnormality, the rationale for treatment, and the precautions recommended after treatment Because the abnormality involved the cervix many women felt their femininity was undermined Women used explanations such as stress, the pill, or sexual activity to make sense of their condition and through these explanations identified things they could do to reduce their risk of cervical cancer