Understanding Patients' Perspectives and Information Needs Following a Positive Home Human Papillomavirus Self-Sampling Kit Result
Understanding Patients' Perspectives and Information Needs Following a Positive Home Human Papillomavirus Self-Sampling Kit Result
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DOI：
10.1089/jwh.2018.7070
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发表时间：
2018-11-27
影响因子：
3.5
通讯作者：
Winer, Rachel L.
中科院分区：
文献类型：
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作者：
Tiro, Jasmin A.;Betts, Andrea C.;Winer, Rachel L.
目的：我们探讨了在人类乳头瘤病毒(HPV)自身采样阳性后患者的观点，以描述这种基于家庭的筛查方式的经验和信息需求。材料和方法：我们招募了在一项务实的试验中检测出高危(HR)HPV阳性的妇女，评估邮寄HrHPV自我采样试剂盒作为在美国综合医疗保健系统中为逾期进行巴氏筛查的妇女的外展策略。电话采访是从2014年到2017年进行的。五名独立的编码员使用迭代内容分析对记录进行分析。结果：46名女性(61%的受邀者，平均年龄55.5岁)完成了一次半结构面试。出现了六个主题：(1)家庭筛查的便利性，(2)收到阳性试剂盒结果后的强烈感觉和情绪，(3)见提供者和讨论试剂盒结果的重要性，(4)从各种来源寻求信息，(5)对HPV和巴氏试验的目的和意义的混淆，以及(6)当随后的巴氏试验正常时，HPV自我采样不准确。结论：尽管女性喜欢试剂盒的便利性，但关于家庭HPV和门诊巴氏结果不一致的讨论导致她们质疑HPV自我采样的准确性。家庭HPV试剂盒周围的患者与提供者的沟通比反射或协同检测更复杂，因为在阳性试剂盒结果呈阳性时，临床医生收集的巴氏结果是未知的。患者需要了解HPV和巴氏检测之间的区别，以及如何将它们用于筛查和后续检查。为了让患者放心，并保持他们对自我采样的兴趣，应该在筛查过程中的多个时间点提供教育。
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.