Knowledge base as a predictor of follow-up compliance after colposcopy

Our aim was to determine patient knowledge of cervical dysplasia and colposcopy at an inner-city obstetrics and gynecology clinic and the relationship of this knowledge base to compliance.

One hundred six women presenting for colposcopy at Thomas Jefferson University Hospital's obstetrics and gynecology clinic during an 8-month period were given questionnaires testing their knowledge of Papanicolaou smears, colposcopy, cervical dysplasia, and cervical cancer. Their medical records were reviewed 12 to 19 months later for patient demographics and follow-up compliance.

Mean patient score on the nine-question test was 3.5 ± 1.7 (score range, 0-8). Answers to individual questions showed that 32.1% of patients understood the purpose of a Papanicolaou smear, 52.8% understood the nature of colposcopy, and 24.4% could identify at least three risk factors for cervical cancer. Overall compliance with planned follow-up was 54.7%. We saw no relationship between test scores and follow-up compliance. Correct answers to individual questions did not correlate with improved compliance. Age, parity, intercurrent pregnancy, and history of previous colposcopy were not predictive of compliance. Follow-up compliance correlated with the colposcopic impression of the severity of disease [79.2% for patients with high-grade lesions versus 46.9% for all others (p = .005)]. A statistical trend was observed in relation to the severity of the initiating cytological diagnosis.

Patient knowledge was poor, as demonstrated by our questionnaire. Compliance did not correlate with questionnaire scores but rather correlated with the colposcopic impression of severity of disease. Increased knowledge in patients, therefore, may not necessarily increase compliance.