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J Womens Health (Larchmt). 2019 Mar;28(3):384-392. doi: 10.1089/jwh.2018.7070. Epub 2018 Nov 27.

Understanding Patients' Perspectives and Information Needs Following a Positive Home Human Papillomavirus Self-Sampling Kit Result.

Author information

1
1 Department of Clinical Sciences, University of Texas Southwestern Medical Center , Dallas, Texas.
2
2 Department of Health Promotion and Behavioral Sciences, UT , School of Public Health in Dallas, Dallas, Texas.
3
3 Kaiser Permanente Washington Health Research Institute , Seattle, Washington.
4
4 Department of Obstetrics and Gynecology, University of Washington , Seattle, Washington.
5
5 Department of Epidemiology, University of Washington , Seattle, Washington.
6
6 Department of Pathology, University of Washington , Seattle, Washington.
7
7 Kaiser Permanente Washington , Renton, Washington.
8
8 Division of Biostatistics, University of California Davis , Davis, California.

Abstract

OBJECTIVE:

We explored patient perspectives after a positive human papillomavirus (HPV) self-sampling result to describe experiences and information needs for this home-based screening modality.

MATERIALS AND METHODS:

We recruited women who tested high-risk (hr) HPV positive during a pragmatic trial evaluating mailed hrHPV self-sampling kits as an outreach strategy for women overdue for Pap screening in a U.S. integrated health care system. Telephone interviews were conducted from 2014 to 2017. Five independent coders analyzed transcripts using iterative content analysis.

RESULTS:

Forty-six women (61% of invited; median age 55.5 years) completed a semistructured interview. Six themes emerged: (1) convenience of home-based screening, (2) intense feelings and emotions after receiving positive kit results, (3) importance of seeing provider and discussing kit results, (4) information seeking from various sources, (5) confusion about purpose and meaning of HPV versus Pap tests, and (6) concern that HPV self-sampling is inaccurate when the subsequent Pap test is normal.

CONCLUSIONS:

Although women liked the kit's convenience, discussion about discordant home HPV and in-clinic Pap results led them to question the accuracy of HPV self-sampling. Patient-provider communication around home HPV kits is more complex than for reflex or cotesting because clinician-collected Pap results are unknown at the time of the positive kit result. Patients need education about differences between HPV and Pap tests and how they are used for screening and follow-up. To reassure patients and keep them interested in self-sampling, education should be provided at multiple time points during the screening process.

KEYWORDS:

early detection of cancer; human papillomavirus DNA tests; mass screening; qualitative research; uterine cervical neoplasms

PMID:
30481121
PMCID:
PMC6444912
[Available on 2020-03-01]
DOI:
10.1089/jwh.2018.7070

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