Effect of professional society recommendations on women's desire for a routine pelvic examination

被引:9
作者
Sawaya, George F. [1 ,3 ]
Smith-McCune, Karen K. [1 ]
Gregorich, Steven E. [2 ]
Moghadassi, Michelle [1 ]
Kuppermann, Miriam [1 ]
机构
[1] Univ Calif San Francisco, Dept Obstet Gynecol & Reprod Sci, San Francisco, CA 94143 USA
[2] Univ Calif San Francisco, Dept Med, San Francisco, CA USA
[3] Univ Calif San Francisco, Ctr Healthcare Value, San Francisco, CA 94143 USA
关键词
patient preferences; patient view; professional society recommendation; routine pelvic examination; CLINICAL-PRACTICE GUIDELINE; SERVICES TASK-FORCE; AMERICAN-COLLEGE; ADULT WOMEN; PHYSICIANS;
D O I
10.1016/j.ajog.2017.05.003
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
BACKGROUND: The American College of Physicians strongly recommends against performing pelvic examinations in asymptomatic, nonpregnant women, citing evidence of harm (false-positive testing, unnecessary surgery) and no evidence of benefit. In contrast, the American Congress of Obstetricians and Gynecologists recommends pelvic examinations in asymptomatic women beginning at age 21 years, citing expert opinion. OBJECTIVE: We sought to evaluate if providing women with professional societies' conflicting statements about pelvic examinations (recommendations and rationales) would influence their desire for a routine examination. STUDY DESIGN: We recruited 452 women ages 21-65 years from 2 women's clinics to participate in a 50-minute face-to-face interview about cervical cancer screening that included a 2-phase study related to pelvic examinations. In the first phase, 262 women were asked about their desire for the examination without being provided information about professional societies' recommendations. In the second phase, 190 women were randomized to review summaries of the American College of Physicians or American Congress of Obstetricians and Gynecologists statement followed by an interview. RESULTS: First-phase participants served as the referent: 79% (208/262) indicated they would want a routine examination if given a choice. In the second phase, a similar percentage of women randomized to the American Congress of Obstetricians and Gynecologists summary had this desire (82%: 80/97; adjusted odds ratio, 1.37; 95% confidence interval, 0.69-2.70). Women randomized to the American College of Physicians summary, however, were less likely to indicate they would opt for an examination (39%: 36/93; adjusted odds ratio, 0.12; 95% confidence interval, 0.06-0.21). Overall, 94% (179/190) believed the potential benefits and harms should be discussed prior to the examination. CONCLUSION: Providing women with a professional society's recommendation advising against routine pelvic examinations substantially reduced their desire to have one. Educational materials are needed to ensure women's informed preferences and values are reflected in decisions about pelvic examinations.
引用
收藏
页码:338.e1 / 338.e7
页数:7
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