Management of the low-grade abnormal Pap smear: What are women's preferences?

OBJECTIVE: To evaluate preferences among ethnically diverse women for the management of a low-grade abnormal Pap smear result: early colposcopy or observation with repeat Pap smears.

STUDY DESIGN: Structured interviews were conducted with 170 women of diverse ethnic backgrounds to assess their preferences. Trained personnel conducted standardized interviews. A standard description of all tests and procedures was read to participants. The participants were presented with scenarios of contrasting management approaches for a hypothetical low-grade abnormal Pap smear result-observation with repeat Pap smear vs. immediate colposcopy.

POPULATION: Study participants were recruited from the waiting rooms of 5 family planning clinics in Northern Californiaamprsquos Central Valley.

OUTCOMES MEASURED: The primary outcome measures for each scenario were utilities (quantified preferences for specific health states) measured by the Standard Gamble.

RESULTS: The range in utilities was large for all scenarios. Mean utilities (SD) for observation: 0.96 ( 0.13) followed by resolution; 0.93 ( 0.17) followed by cryotherapy; 0.91 ( 0.21) followed by cone biopsy. Mean utilities for early colposcopy: 0.93 ( 0.20) followed by resolution; 0.95 ( 0.14) followed by cryotherapy; and 0.92 ( 0.16) followed by cone biopsy. Subject characteristics explained less than 20% of the variance in utilities. Decision analysis gave a slightly higher overall utility for early colposcopy (0.940 vs 0.932 for observation), but was sensitive to small changes in branch utilities.

CONCLUSIONS: Womenamprsquos preferences for management of a low-grade abnormal Pap result vary widely. Clinicians should adopt a flexible approach to the management of low-grade abnormal Pap smears to incorporate individual preferences.