Samhället ställer ökade krav på uppföljning av hälso- och sjukvårdens kvalitet. Individualiserad vård anges som något av det mest centrala i vården och omvårdnaden av patienten (ICN, 2006) och betonas i olika policy- och kvalitetsdokument både nationellt och internationellt (Nilsson, 2005, OECD, 2004). I närsjukvårdsprofileringen och utvecklingen som redovisats för Nordöstra Skåne betonas att vården skall utgå från patientens behov (Region Skåne, 2003) och innefatta utveckling av nya vård- och behandlingsformer där patienten och närstående står i fokus. Behovet av vård och omvårdnad och dess utförande varierar då en patient blir inlagd på sjukhus och det är viktigt att beakta att patienten och dennes närstående kan känna sig sårbara och utsatta (Hälso- och Sjukvårdsrapporten från 2001). Utvärderingar som belyser ett helhetsperspektiv på vårdtagarna är viktiga och måste innehålla både medicinska- och omvårdnadsdata. I föreliggande rapport är det det omvårdnadsperspektivet som står i centrum.
A Papanicolaou (Pap) smear can be used to detect pre-cancerous cellular changes, so that they can be treated before they develop into cervical cancer. When the results of a Pap smear test are abnormal, women need further investigation, treatment and follow-up. Healthcare professionals (HCPs) are in a position to care for these women with abnormalities. The aim of this study was to explore the experiences of HCPs in caring for women with abnormal Pap smear results. In total, 20 HCPs from two counties in south-eastern Sweden participated in individual interviews, based on two open-ended questions. Interviews were recorded, transcribed verbatim and analysed using content analysis. The results showed that HCPs experienced that abnormal Pap smear results created anxiety in women, who often sought information from the Internet as a way to cope. Furthermore, the HCPs thought that it was a problem that women chose not to attend investigation, treatment and follow-ups. However, information about the seriousness of abnormal Pap smear results causes women to participate. It is a challenge for HCPs to inform in a reassuring manner. Finally, HCPs should collaborate with women to meet their information needs and to also provide support regarding finding and filtering reliable information on the Internet.
BACKGROUND: Cervical dysplasia is a precancerous condition, which has been shown to create anxiety in women. To be able to investigate these women's health-related quality of life, a disease-specific instrument is required. There does not seem to be a Swedish version of an instrument to screen for this specific disease. Therefore, this study aims to translate and cross-culturally adapt the Functional Assessment of Chronic Illness Therapy - Cervical Dysplasia (FACIT-CD) into a Swedish context and evaluate its linguistic validity and reliability.
METHODS: The Functional Assessment of Chronic Illness Therapy (FACIT) translation methodology was used, which consists of several steps including pilot testing of the FACIT-CD instrument through cognitive debriefing interviews. Ten women diagnosed with cervical dysplasia participated in the cognitive debriefing interviews. The internal consistency reliability of the Swedish FACIT-CD was estimated by Cronbach's alpha coefficient. Homogeneity of the items was evaluated by corrected item-total correlations. The sample consists of 34 women who were diagnosed with cervical dysplasia.
RESULTS: The translation and cross-cultural adaptation went smoothly without any problems for the majority of the items. The cognitive debriefing interviews indicated that the Swedish FACIT-CD consists of relevant items, is easy to understand and complete, and has unambiguous and comprehensive response categories. The translation and cross-cultural adaptation resulted in a Swedish FACIT-CD, which is conceptually and semantically equivalent to the English version and linguistically valid. The total scale of the Swedish FACIT-CD exhibited good internal consistency reliability with a Cronbach's alpha coefficient of 0.84, and all of the subscales exhibited acceptable value between 0.71 and 0.81 except the Relationships subscale, which had a value of 0.67. Finally, all but four items exceeded the acceptable level for the corrected item-total correlations of ≥ 0.20.
CONCLUSIONS: The Swedish FACIT-CD is conceptually and semantically equivalent to the English version and linguistically valid; further, it exhibits good internal consistency reliability.
OBJECTIVES: To describe women's experiences of abnormal Pap smear result.
METHODS: Ten women were recruited from a women's health clinic. Qualitative interviews based on six open-ended questions were conducted, transcribed verbatim, and analyzed by content analysis.
RESULTS: The women believed that their abnormal Pap smear result was indicative of having cancer. This created anxiety in the women, which resulted in the need for emotional support and information. Testing positive with human papillomavirus (HPV) also meant consequences for the relatives as well as concerns about the sexually transmitted nature of the virus. Finally, the women had a need to be treated with respect by the healthcare professionals in order to reduce feelings of being abused.
CONCLUSIONS: In general, women have a low level of awareness of HPV and its relation to abnormal Pap smear results. Women who receive abnormal Pap smear results need oral information, based on the individual women's situation, and delivered at the time the women receive the test result. It is also essential that a good emotional contact be established between the women and the healthcare professionals.
This study aims to assess whether notification of an abnormal Pap smear result via a phone call, delivered by a trained healthcare provider, has an effect on women's HRQoL, coping and awareness of HPV. For this intervention study, women were consecutively recruited from a women's health clinic in Sweden. Women in the intervention group (n = 113) were notified of their Pap smear result via a phone call by a trained healthcare provider, while those in the comparison group (n = 122) were notified via a standard letter. A questionnaire was used to collect data. The results found no significant differences between the groups for HRQoL. However, 42.5% of women in the intervention group versus 48.3% in the comparison group reported anxiety. Women in the intervention group were more satisfied with the manner in which they were notified of their abnormal result than those in the comparison group (92.0% vs. 67.2%; p < 0.001), more aware of HPV (71% vs. 50%; p = 0.001), and called healthcare services less often (10.6% vs. 18.0%; p = 0.113), no significance. In conclusion, notification of an abnormal Pap smear result via a phone call does not increase women's HRQoL or reduce their anxiety.
This study aims to assess (a) women's awareness of the human papillomavirus (HPV), (b) women's health-related quality of life (HRQoL) and levels of anxiety and depression symptoms, and (c) to compare the outcomes between women who are aware of the sexually transmitted nature of the HPV infection and women who are not. Swedish women who have been notified of an abnormal Pap smear result completed a questionnaire. This questionnaire consisted of sociodemographic characteristics, items on awareness of HPV, and how to cope with the Pap smear result and the instruments: the Functional Assessment of Chronic Illness Therapy - Cervical Dysplasia and the Hospital Anxiety and Depression Scale (HADS). Data were analyzed using descriptive statistics, Student's t-test, χ-tests, Fisher's exact test, the Mann-Whitney U-test, and Fisher-Freeman-Halton exact test. In total, 122 women participated. The women reported a median (quartile 1-quartile 3) score of 87.6 on the Functional Assessment of Chronic Illness Therapy - Cervical Dysplasia (81.8-107.0), compatible with a good HRQoL. The median (quartile 1-quartile 3) scores on HADS-anxiety and HADS-depression were 7.0 (4.0-10.0) and 3.0 (1.0-5.3), respectively; however, 48.4% of the women reported anxiety (compared with 20% in a normal population). There were no statistically significant differences in the median scores in any of the scales, including the prevalence of distress between the subgroups. Women with abnormal Pap smear results have a good HRQoL; they can become anxious, but not depressed. Awareness of HPV as a sexually transmitted infection is low, but being aware does not impact on women's HRQoL or on anxiety and depression.