Beyond the Pap: assessing patients' priorities for the annual examination

Recent cervical cancer screening technologies depend on biennial and triennial screening of cytologically normal women to be cost-effective. The guidelines for these technologies cannot be appropriately implemented if women demand continued cervical screening at their annual examinations. The purpose of this study was to identify the reasons for an annual examination that are important to women.

Age-specific focus groups elicited 22 consistently important reasons that were then incorporated into a survey given to northern New England women seeking healthcare. The reasons were classified as test-seeking reasons and as provider-patient relationship reasons. A distribution matrix of the test-seeking and provider-patient relationship reasons was constructed for paired McNemar chi-square analysis. Multivariate regression analyses compared the selected reasons to the women's demographic characteristics.

There were 121 women from three distinct primary care offices who completed the surveys. Women were highly likely to chose patient-provider reasons as more important components of the annual examination than test-seeking reasons (chi-square for symmetry = 54.44, p < 0.001). The lesser importance of an annual Pap test did not vary by age, education level, and number of healthcare visits made in the last year.

Our results indicate that northern New England women value the provider-patient relationship as paramount for the annual examination, thus supporting the notion that the biennial and triennial Pap intervals for cytologically normal women provided by the new cervical cancer screening technologies would be acceptable in this population.