title: Women's experiences of abnormal cervical cytology: illness representations, care processes, and outcomes.
abstract: BACKGROUND
  We wanted to explore the conceptual representations of illness and experiences with care among women who have learned of an abnormal Papanicolaou (Pap) smear result.
  
  
  METHODS
  The study took place in 2 primary care, family practice clinics serving low-income, multiethnic patients in the Bronx, New York City. We conducted qualitative, semistructured telephone interviews with 17 patients who had recently learned of abnormal findings on a Pap smear. After a preliminary coding phase, the investigators identified 2 important outcomes: distress and dissatisfaction with care, and factors affecting these outcomes. A model was developed on a subset of the data, which was then tested on each transcript with an explicit search for disconfirming cases. A revised coding scheme conforming to the dimensions of the model was used to recode transcripts.
  
  
  RESULTS
  Women reported complex, syncretic models of illness that included both biomedical and folk elements. Many concerns, especially nonbiomedical concerns, were not addressed in interactions with physicians. An important source of both distress and dissatisfaction with care was the women's lack of understanding of the inherent ambiguity of Pap smear results. When perceived care needs, which included emotional support as well as information, were not met, distress and dissatisfaction were greatly increased.
  
  
  CONCLUSIONS
  In this study, patients' illness models and expectations of care were not routinely addressed in their conversations with physicians about abnormal Pap smear results. When physicians can take the time to review patients' illness models carefully, distress and dissatisfaction with care can be reduced considerably.
authors.affiliation: Department of Family Medicine, Albert Einstein College of Medicine, Bronx, NY 10467, USA. akkarasz@montefiore.org
authors.forename: Alison
authors.initials: A
authors.lastname: Karasz
authors.forename: M Diane
authors.initials: MD
authors.lastname: McKee
authors.forename: Krista
authors.initials: K
authors.lastname: Roybal
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D008960:Models, Psychological; D009519:New York City; D010043:Outcome and Process Assessment, Health Care; D065006:Papanicolaou Test; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D013315:Stress, Psychological / Q000517:prevention & control; D002578:Uterine Cervical Dysplasia / Q000523:psychology*; D014626:Vaginal Smears / Q000523:psychology*