Background
With the introduction of oncogenic Human Papillomavirus (HPV) testing into cervical screening there is a renewed focus on primary prevention among high-risk groups. To date, little is known about the effectiveness of this program, and the extent to which individual-level factors, such as psychosocial health and agency, may play a role. In particular,
it is unclear if knowledge of one’s oncogenic HPV status impacts on adherence behaviors amongst women with screening abnormalities. The purpose of this study was to identify if clinical, demographic or psychosocial factors predict non-adherence with recommended colposcopy follow-up.
Methods
This prospective pilot study included 145 women referred to a large Toronto colposcopy clinic between December, 2013 and September, 2014. Demographic, clinical and psychosocial characteristics were collected at three points in time: (1) at initial colposcopy consultation; (2) 4–6 weeks following initial consultation, and; (3) at time of follow-up appointment (within 12 months of initial consultation).
Results
Overall, 13% (n = 145) of the women were classified as non-adherent. Older women (OR = 0.73, p < 0.01) and those with higher-grade lesions (OR = 0.10, p < 0.01) were less likely to be non-adherent, whereas current smokers (OR = 22.46, p < 0.01) were more likely to be non-adherent. While not statistically significant, variation in rates of non-adherence amongst the various HPV status groups (untested; 15.3%, HPV positive; 5.3%, HPV negative; 6.7%) warrants further study.
Conclusion
Findings of this study indicate that younger women, those with higher-grade lesions and current smokers were more likely to be non-adherent to recommended colposcopy follow-up. While HPV status did not reach statistical significance, the direction of this finding suggests that testing for HPV may have a positive reinforcing role on adherence to follow-up. The direction of this finding warrants further study, and potentially a practical clinical goal as HPV testing for women becomes standard of care.
In Canada, approximately 1,500 women are diagnosed with cervical cancer every year, and 581 will die of the disease (WHO/ICO Information Centre on HPV and Cervical Cancer, 2007). The importance of preventing cervical cancer is clear, as the effects that this disease has on the lives of women and their families regardless of culture, sex, nationality or country is evident. With the recent media attention and release of the Human Papillomavirus (HPV) vaccine in Canada, it is crucial that oncology nurses understand HPV, its role in the development of cervical cancer, and the HPV vaccine. A brief overview of HPV and its involvement in the development of cervical cancer will be discussed in this paper. In addition, information on the HPV vaccine and its implications, as well as the current policy for the vaccine in Canada will be addressed. It will become evident how the role of the oncology nurse, as an educator and advocate regarding the implementation of this vaccine is crucial for successful acceptance of this vaccine. Finally, future implications of the vaccine and avenues of research will be touched upon.
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