ASPO Abstracts
Understanding Women's Perspectives and Information Needs Following a Positive HPV Self-Sampling Test Result
Category: Early Detection & Risk Prediction, Behavioral Science & Health Communication
Conference Year: 2018
Abstract Body:
Background At-home HPV self-screening kits with triage of high-risk HPV+ women to in-clinic follow- up may improve cervical cancer screening adherence. Understanding patient experience after a positive kit result is essential to optimize delivery and minimize negative perceptions of self-screening. We explored patient perspectives after a HPV+ self- screening result to identify information needs and emotional responses to this new screening modality. Methods We conducted a pragmatic randomized controlled trial in Kaiser Permanente Washington (an integrated healthcare system) to compare two programmatic approaches for increasing screening among women aged 30-64 years who were overdue (3.4 years since last Pap; see abstract #218 for details). Control arm included usual care (annual reminders and adhoc clinic outreach). Intervention arm included usual care plus an unsolicited mailed HPV self-sampling kit. We recruited 46 kit returners who tested HPV+ (62% of invited; median age 55.5 years) to complete a semi-structured interview and a brief survey. Most women completed timely diagnostic evaluation (85% had a Pap and/or colposcopy, mean=15 [IQR=10-35] days between HPV+ result and first in clinic procedure). Four coders analyzed transcripts using iterative content analysis. Results Seven themes emerged: 1) convenience of home test; 2) surprised by kit results because low perceived risk of HPV infection; 3) anxiety and urgency to follow up and discuss results with provider; 4) poor understanding of kit results and subsequent information- seeking through Internet, patient portal, and family/friends; 5) provider communications about results eased patient worry; 6) confusion about purpose and meaning of HPV versus Pap results; and 7) concern that HPV self-screening was inaccurate when follow- up Pap was normal. Most women strongly agreed their experience using the kit was positive; but only 65% agreed they trusted the HPV result and 59% believed it was correct. Conclusion Although women liked the test’s convenience, communication about discordant home HPV and in-clinic Pap results led some to question accuracy of self-screening. Patient- provider communication around self-screening is more complex than for reflex or co- testing, because clinician-collected Pap results are
Keywords: self-sampling; primary HPV screening