title: Emergency department pelvic examination and Pap testing: addressing patient misperceptions.
abstract: OBJECTIVE
  Failure to obtain cervical cancer screening can be precipitated by limited knowledge. This study describes understanding of Papanicolaou (Pap) smear testing among women undergoing emergency department (ED) pelvic examination and tests the feasibility of educating patients in the ED.
  
  
  METHODS
  Patients undergoing pelvic examination in an urban, tertiary care ED were surveyed about Pap smear screening. Among the initial cohort, no education was provided prior to survey administration. Subsequently, a pilot study of scripted information provided by physicians alone or both physicians and counselors was conducted.
  
  
  RESULTS
  There were 81 patients in the non-intervention cohort and 32 patients in the intervention cohort. Of the 32 intervention patients, 16 received physician-administered intervention, and 16 received reinforced counseling (physician + counselor). Of 113 total patients, 90 (82%) were African American; mean age was 26 years (SD +/- 7.7 years). Of the 81 non-intervention patients, six (7%; 95% CI = 3% to 15%) said they were told that a Pap test was not done, and 60 (74%; 95% CI = 64% to 82%) mistakenly believed they had a Pap test. Sixty-six (81.5%; 95% CI = 72% to 88%) patients stated they knew the purpose of a Pap test; only 17 (26%; 95% CI = 17% to 37%) of these correctly identified the Pap test as a test for cervical cancer. All 32 intervention patients were surveyed after physician counseling. Compared with the non-intervention group, fewer (56%; 95% CI = 39% to 72%) thought they had a Pap test, and more (31%; 95% CI = 18% to 49%) said they were told they did not receive a Pap test. All 16 reinforced intervention patients correctly denied receiving a Pap test after counselor education.
  
  
  CONCLUSIONS
  Knowledge of Pap testing among women undergoing ED pelvic examination is poor; most mistakenly believe they receive a Pap test during ED evaluation. Educating patients may be feasible and effective in the ED setting.
authors.affiliation: Department of Emergency Medicine, University of Cincinnati College of Medicine, University Medical Center, PO Box 670769, 231 Albert Sabin Way, Cincinnati, OH 45267-0769, USA. lyonsme@ucmail.uc.edu
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lyons
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lindsell
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Trott
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D065006:Papanicolaou Test; D010353:Patient Education as Topic / Q000379:methods; D010388:Pelvis; D010808:Physical Examination / Q000706:statistics & numerical data*; D010865:Pilot Projects; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D014626:Vaginal Smears / Q000706:statistics & numerical data*