Adherence to care plan in women with abnormal Papanicolaou smears: a review of barriers and interventions.
BACKGROUND
Cancer of the cervix is preventable. According to the Surveillance, Epidemiology, and End Results (SEER) Program, invasive cervical cancer incidence is 9.0 and cancer mortality rate is 2.8 per 100,000 persons. Effective prevention includes appropriate use of Papanicolaou smears and adherence to a care plan by the patient. This review will examine the extent of nonadherence, negative outcomes, barriers, and interventions for improved adherence to care.


METHODS
Computer searches in MEDLINE for English language articles were conducted from 1968 to 1999 using the key words "colposcopy," "abnormal Papanicolaou smear," "patient compliance," "adherence to care," and "follow-up."


RESULTS
Although there is 10% to 40% nonadherence in the studies reviewed, the definition of nonadherence is not standard. Considerable morbidity from cervical cancer was described among nonadherent women. The most common barriers to follow-up were lack of understanding of the purpose of colposcopy, fear of cancer, forgetting appointments, and lack of time, money, or childcare. Emotional consequences of abnormal Papanicolaou smears had considerable impact on follow-up visits. Focused intervention strategies targeted to the study population were most effective in improving adherence.


CONCLUSIONS
Nonadherence results from the interplay of emotional, logistic, cultural, or socioeconomic factors. Among the most effective strategies to improve adherence are personalized reminders to patients by their primary physicians and case management dictated by the size, structure, and style of the practice.
Khanna
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Department of Family Medicine, University of Maryland School of Medicine, Baltimore 21201, USA.
Phillips
M D
MD
D019090:Case Management; D002584:Cervix Uteri / Q000473:pathology*; D018450:Disease Progression; D005194:Family Practice; D005260:Female; D006801:Humans; D065006:Papanicolaou Test; D010349:Patient Compliance / Q000523:psychology*; D017010:Reminder Systems; D012959:Socioeconomic Factors; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control* / Q000523:psychology; D014626:Vaginal Smears