Perceptions and experiences of patients and clinicians of anal cancer screening: a hermeneutic phenomenological study

Anal intraepithelial neoplasia (AIN) is a well-recognised precursor to invasive anal squamous cell carcinoma. The prevalence of anal cancer is increasing in people living with HIV. This hermeneutic phenomenology study explored the perceptions and experiences of patients and clinicians in anal cytology screening and high resolution anoscopy in sexual health clinics in the UK.

The study was conducted using the interpretative paradigm using hermeneutic phenomenology informed by Heidegger. A purposive sample comprising 14 patients and 8 clinicians was recruited. In-depth unstructured interviews were conducted as part of a Doctorate in Nursing that was completed in 2020. Interpretive phenomenological analysis (IPA) was used to develop in-depth interpretations of participants' perceptions and experiences of anal cancer screening. Data were analysed using the six stages in the analysis process, that is, immersion; understanding; abstraction; synthesis and theme development; illumination and illustration of phenomena; integration and critique.

Five themes emerged from the data from both patients and clinicians: psychological effects of anal cancer screening; screening procedures; education, knowledge and training; social and sexual activity; guidelines and practices. The study demonstrated that anal cancer screening is acceptable, but tolerability is variable; and education, knowledge and information on anal cancer screening is limited. Although the social life of most patients was not affected, their sexual activity was impacted. The author recommends introducing a screening programme as part of routine HIV care in outpatient sexual health clinics.

Anal cancer screening benefits outweigh any psychological harm caused by tests and diagnostic procedures for people living with HIV. The emotional responses highlighted were not associated with significant psychological harm. Anal cancer screening should be considered in future guidelines in the UK for people living with HIV.