title: Women's triage and management preferences for cervical cytologic reports demonstrating atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesions.
abstract: OBJECTIVE
  To determine women's triage test preferences for the evaluation and management of atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL) Papanicolaou smear reports.
  
  
  METHODS
  A 35-item questionnaire.
  
  
  METHODS
  Primary care clinic waiting rooms.
  
  
  METHODS
  A convenience sample of 968 women.
  
  
  METHODS
  Women received standardized descriptions of the meaning of ASCUS and LSIL Papanicolaou smear classifications and uniform descriptions of the 4 triage tests: Papanicolaou smear, human papillomavirus DNA test, cervicography, and colposcopy.
  
  
  METHODS
  Subjects' responses to questionnaire.
  
  
  RESULTS
  More women (58.4%) preferred a repeat Papanicolaou smear for an ASCUS report than would choose human papillomavirus DNA testing (7.3%), cervicography (20.6%), or colposcopy (13.8%) (P < .001, chi 2). Alternatively, 51% of women wanted colposcopy to evaluate an LSIL report compared with the other 3 options (P < .001, chi 2). Test accuracy was the most important factor that influenced women's decisions for each test, compared with cost, discomfort, and other reasons (P < .001, chi 2). Positive predictors for women's selection of colposcopy to evaluate a Papanicolaou smear showing LSIL included older age (P < .01, logistic regression analysis), higher level of income (P < .001, chi 2), greater level of education (P < .001, logistic regression analysis), greater level of knowledge of colposcopy and Papanicolaou smears (P < .001, logistic regression analysis), family history of cervical cancer (P < .01, chi 2), and history of cervical dysplasia (P = .02, chi 2).
  
  
  CONCLUSIONS
  Most women preferred a repeat Papanicolaou smear to further evaluate an initial Papanicolaou smear demonstrating ASCUS and colposcopy to evaluate a report of LSIL. Women identified test accuracy as the most important reason for triage test selection. Multiple factors, primarily involving patient and family history of cervical neoplasia, level of education, income, age, and knowledge of tests, influence women's desire for specific triage tests. Because no optimal management of women with ASCUS and LSIL Papanicolaou smear reports has been determined, consideration of women's triage test preferences should complement overall patient care.
authors.affiliation: Medical Effectiveness Education and Research Program, Medical College of Georgia, Augusta, USA.
authors.forename: D G
authors.initials: DG
authors.lastname: Ferris
authors.forename: D
authors.initials: D
authors.lastname: Kriegel
authors.forename: L
authors.initials: L
authors.lastname: Cote
authors.forename: M
authors.initials: M
authors.lastname: Litaker
authors.forename: L
authors.initials: L
authors.lastname: Woodward
mesh_terms: D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000821:virology; D003127:Colposcopy; D004279:DNA, Viral / Q000302:isolation & purification; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000235:genetics; D011795:Surveys and Questionnaires; D014218:Triage; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000821:virology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000821:virology; D014626:Vaginal Smears
chemical_list: D004279:DNA, Viral