title: Interventions for reducing anxiety in women undergoing colposcopy.
abstract: BACKGROUND
  Prior to the development of cervical cancer abnormal cervical cells can be detected on a cervical smear. The usual practice following an abnormal cervical smear is to perform colposcopy. Colposcopy is the visualisation of the cervix using a binocular microscope. Women experience high levels of anxiety and negative emotional responses at all stages of cervical screening. High levels of anxiety before and during colposcopy can have adverse consequences, including pain and discomfort during the procedure and high loss to follow-up rates. This review evaluates interventions designed to reduce anxiety levels during colposcopic examination.
  
  
  OBJECTIVE
  To compare the efficacy of various interventions aimed at reducing anxiety during colposcopic examination in women.
  
  
  METHODS
  We searched the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Issue 3, 2010, MEDLINE and EMBASE up to July 2010. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field.
  
  
  METHODS
  Randomised controlled trials (RCTs) of interventions to reduce anxiety during colposcopic examination.
  
  
  METHODS
  Two review authors independently abstracted data and assessed risk of bias. Mean differences for anxiety levels, knowledge scores, pain, patient satisfaction and psychosexual dysfunction in women who underwent colposcopy were pooled in a random effects meta-analyses.
  
  
  RESULTS
  We found six trials that met our inclusion criteria. These trials assessed the effectiveness of different interventions for reducing anxiety in women undergoing colposcopy for the first time.All comparisons were restricted to single trial analyses or meta analysis of just two trials. There was evidence from a reasonably large trial (n = 220) that was at low risk of bias to suggest that music during colposcopy significantly reduced anxiety levels (MD = -4.80, 95% CI: -7.86 to -1.74) and pain experienced during the procedure (MD = -1.71, 95% CI: -2.37 to -1.05) compared to not listening to music. There was no statistically significant difference between anxiety levels prior to colposcopy in women receiving information leaflets versus no leaflets and information leaflets, video and counselling versus information leaflets and video with no counselling. However, knowledge scores were significantly higher and psychosexual dysfunction scores were significantly lower in women who received leaflets compared to those who did not so there was some sort of benefit to giving patients information leaflets. There is evidence for video colposcopy from a quasi randomised trial which assessed 81 women showing significant anxiety reduction.
  
  
  CONCLUSIONS
  Anxiety appears to be reduced by playing music during colposcopy. Although information leaflets did not reduce anxiety levels, they did increase knowledge levels and are therefore useful in obtaining clinical consent to the colposcopic procedure. Leaflets also contributed to improved patient quality of life by reducing psychosexual dysfunction.
authors.affiliation: Gynaecological Oncology, Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK, NE9 6SX.
authors.forename: Khadra
authors.initials: K
authors.lastname: Galaal
authors.forename: Andrew
authors.initials: A
authors.lastname: Bryant
authors.forename: Katherine Ho
authors.initials: KH
authors.lastname: Deane
authors.forename: Maha
authors.initials: M
authors.lastname: Al-Khaduri
authors.forename: Alberto D
authors.initials: AD
authors.lastname: Lopes
mesh_terms: D001007:Anxiety / Q000517:prevention & control*; D003127:Colposcopy / Q000009:adverse effects / Q000523:psychology*; D005260:Female; D006801:Humans; D018715:Microscopy, Video; D009147:Music Therapy; D010146:Pain / Q000209:etiology; D010147:Pain Measurement / Q000379:methods; D010174:Pamphlets; D010353:Patient Education as Topic; D016032:Randomized Controlled Trials as Topic; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000523:psychology