Management of the low-grade abnormal Pap smear: What are women's preferences?
OBJECTIVE
To evaluate preferences among ethnically diverse women for the management of a low-grade abnormal Pap smear result: early colposcopy or observation with repeat Pap smears.


METHODS
Structured interviews were conducted with 170 women of diverse ethnic backgrounds to assess their preferences. Trained personnel conducted standardized interviews. A standard description of all tests and procedures was read to participants. The participants were presented with scenarios of contrasting management approaches for a hypothetical low-grade abnormal Pap smear result-observation with repeat Pap smear vs. immediate colposcopy.


METHODS
Study participants were recruited from the waiting rooms of 5 family planning clinics in Northern Californiaamprsquos Central Valley.


METHODS
The primary outcome measures for each scenario were utilities (quantified preferences for specific health states) measured by the Standard Gamble.


RESULTS
The range in utilities was large for all scenarios. Mean utilities (SD) for observation: 0.96 (  0.13) followed by resolution; 0.93 (  0.17) followed by cryotherapy; 0.91 (  0.21) followed by cone biopsy. Mean utilities for early colposcopy: 0.93 (  0.20) followed by resolution; 0.95 (  0.14) followed by cryotherapy; and 0.92 (  0.16) followed by cone biopsy. Subject characteristics explained less than 20% of the variance in utilities. Decision analysis gave a slightly higher overall utility for early colposcopy (0.940 vs 0.932 for observation), but was sensitive to small changes in branch utilities.


CONCLUSIONS
Womenamprsquos preferences for management of a low-grade abnormal Pap result vary widely. Clinicians should adopt a flexible approach to the management of low-grade abnormal Pap smears to incorporate individual preferences.
Melnikow
Joy
J
Department of Family and Community Medicine, University of California, Davis, Sacramento 95817, USA. jamelnikow@ucdavis.edu
Kuppermann
Miriam
M
Birch
Stephen
S
Chan
Benjamin K S
BK
Nuovo
Jim
J
D000293:Adolescent; D000328:Adult; D002140:California; D003127:Colposcopy; D017679:Cryotherapy; D003657:Decision Making; D003663:Decision Trees; D003697:Delphi Technique; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D065006:Papanicolaou Test; D017060:Patient Satisfaction; D012044:Regression Analysis; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000628:therapy; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000517:prevention & control / Q000628:therapy; D014626:Vaginal Smears