Who defaults from colposcopy? A multi-centre, population-based, prospective cohort study of predictors of non-attendance for follow-up among women with low-grade abnormal cervical cytology

Linda Sharp*, Seonaidh Cotton, Alison J Thornton, Nicola Gray, Margaret Cruickshank, David Whynes, Ian Duncan, Robert Hammond, Louise Smart, Julian Little, The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group

*Corresponding author for this work

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objective: The success of cervical screening relies on women with abnormal cervical cytology attending for follow-up by colposcopy and related procedures. Failure to attend for colposcopy, however, is a common problem in many countries. The objective of this study was to identify factors associated with non-attendance at an initial colposcopy examination among women with low-grade abnormal cervical cytology.

Study design: A cohort study was conducted within one arm of a multi-centre, population-based randomised controlled trial nested within the UK NHS Cervical Screening Programmes. The trial recruited women aged 20-59 years with recent low-grade cervical cytology; women randomised to immediate referral for colposcopy were included in the current analysis (n = 2213). At trial recruitment, women completed a socio-demographic and lifestyle questionnaire; 1693 women in the colposcopy arm were also invited to complete a psychosocial questionnaire, including the Hospital Anxiety and Depression Scale. Women were sent up to two colposcopy appointments. A telephone number was provided to reschedule if necessary. Defaulters were defined as those who failed to attend after two appointments. Logistic regression methods were used to compute multivariate odds ratios (OR) to identify variables significantly associated with default.

Results: 148 women defaulted (6.7%, 95%Cl 5.7-7.8%). In multivariate analysis, risk of default was significantly raised in those not in paid employment (OR = 2.70, 95%Cl 1.64-4.43) and current smokers (OR = 1.62, 95%Cl 1.12-2.34). Default risk deceased with increasing age and level of post-school education/training and was lower in women with children (OR = 0.59, 95%Cl 0.35-0.98). Among the subgroup invited to complete psychosocial questionnaires, women who were not worried about having cervical cancer were significantly more likely to default (multivariate OR = 1.56, 95%Cl 1.04-2.35).. Anxiety and depression were not significantly associated with default.

Conclusions: Women at highest risk of default from colposcopy are younger, not in paid employment, smoke, lack post-school education, have not had children and are not worried about having cervical cancer. Findings such as these could inform the development of tools to predict the likelihood that an individual woman will default from follow-up. Interventions to minimise default also deserve consideration, but a better understanding of reasons for default is needed to inform intervention development. (C) 2012 Published by Elsevier Ireland Ltd.

Original languageEnglish
Pages (from-to)318-325
Number of pages8
JournalEuropean Journal of Obstetrics & Gynecology and Reproductive Biology
Volume165
Issue number2
DOIs
Publication statusPublished - Dec 2012

Keywords

  • colposcopy
  • abnormal cervical cytology
  • default
  • non-attendance
  • cervical screening
  • PAP-smear
  • health literacy
  • adherence
  • knowledge
  • smoking
  • anxiety
  • adults
  • cost

Cite this

Who defaults from colposcopy? A multi-centre, population-based, prospective cohort study of predictors of non-attendance for follow-up among women with low-grade abnormal cervical cytology. / Sharp, Linda; Cotton, Seonaidh; Thornton, Alison J; Gray, Nicola; Cruickshank, Margaret; Whynes, David; Duncan, Ian; Hammond, Robert; Smart, Louise; Little, Julian; The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group.

In: European Journal of Obstetrics & Gynecology and Reproductive Biology, Vol. 165, No. 2, 12.2012, p. 318-325.

Research output: Contribution to journalArticle

Sharp, Linda ; Cotton, Seonaidh ; Thornton, Alison J ; Gray, Nicola ; Cruickshank, Margaret ; Whynes, David ; Duncan, Ian ; Hammond, Robert ; Smart, Louise ; Little, Julian ; The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group. / Who defaults from colposcopy? A multi-centre, population-based, prospective cohort study of predictors of non-attendance for follow-up among women with low-grade abnormal cervical cytology. In: European Journal of Obstetrics & Gynecology and Reproductive Biology. 2012 ; Vol. 165, No. 2. pp. 318-325.
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title = "Who defaults from colposcopy?: A multi-centre, population-based, prospective cohort study of predictors of non-attendance for follow-up among women with low-grade abnormal cervical cytology",
abstract = "Objective: The success of cervical screening relies on women with abnormal cervical cytology attending for follow-up by colposcopy and related procedures. Failure to attend for colposcopy, however, is a common problem in many countries. The objective of this study was to identify factors associated with non-attendance at an initial colposcopy examination among women with low-grade abnormal cervical cytology.Study design: A cohort study was conducted within one arm of a multi-centre, population-based randomised controlled trial nested within the UK NHS Cervical Screening Programmes. The trial recruited women aged 20-59 years with recent low-grade cervical cytology; women randomised to immediate referral for colposcopy were included in the current analysis (n = 2213). At trial recruitment, women completed a socio-demographic and lifestyle questionnaire; 1693 women in the colposcopy arm were also invited to complete a psychosocial questionnaire, including the Hospital Anxiety and Depression Scale. Women were sent up to two colposcopy appointments. A telephone number was provided to reschedule if necessary. Defaulters were defined as those who failed to attend after two appointments. Logistic regression methods were used to compute multivariate odds ratios (OR) to identify variables significantly associated with default.Results: 148 women defaulted (6.7{\%}, 95{\%}Cl 5.7-7.8{\%}). In multivariate analysis, risk of default was significantly raised in those not in paid employment (OR = 2.70, 95{\%}Cl 1.64-4.43) and current smokers (OR = 1.62, 95{\%}Cl 1.12-2.34). Default risk deceased with increasing age and level of post-school education/training and was lower in women with children (OR = 0.59, 95{\%}Cl 0.35-0.98). Among the subgroup invited to complete psychosocial questionnaires, women who were not worried about having cervical cancer were significantly more likely to default (multivariate OR = 1.56, 95{\%}Cl 1.04-2.35).. Anxiety and depression were not significantly associated with default.Conclusions: Women at highest risk of default from colposcopy are younger, not in paid employment, smoke, lack post-school education, have not had children and are not worried about having cervical cancer. Findings such as these could inform the development of tools to predict the likelihood that an individual woman will default from follow-up. Interventions to minimise default also deserve consideration, but a better understanding of reasons for default is needed to inform intervention development. (C) 2012 Published by Elsevier Ireland Ltd.",
keywords = "colposcopy, abnormal cervical cytology, default, non-attendance, cervical screening, PAP-smear, health literacy, adherence, knowledge, smoking, anxiety, adults, cost",
author = "Linda Sharp and Seonaidh Cotton and Thornton, {Alison J} and Nicola Gray and Margaret Cruickshank and David Whynes and Ian Duncan and Robert Hammond and Louise Smart and Julian Little and {The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group}",
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pages = "318--325",
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TY - JOUR

T1 - Who defaults from colposcopy?

T2 - A multi-centre, population-based, prospective cohort study of predictors of non-attendance for follow-up among women with low-grade abnormal cervical cytology

AU - Sharp, Linda

AU - Cotton, Seonaidh

AU - Thornton, Alison J

AU - Gray, Nicola

AU - Cruickshank, Margaret

AU - Whynes, David

AU - Duncan, Ian

AU - Hammond, Robert

AU - Smart, Louise

AU - Little, Julian

AU - The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group

PY - 2012/12

Y1 - 2012/12

N2 - Objective: The success of cervical screening relies on women with abnormal cervical cytology attending for follow-up by colposcopy and related procedures. Failure to attend for colposcopy, however, is a common problem in many countries. The objective of this study was to identify factors associated with non-attendance at an initial colposcopy examination among women with low-grade abnormal cervical cytology.Study design: A cohort study was conducted within one arm of a multi-centre, population-based randomised controlled trial nested within the UK NHS Cervical Screening Programmes. The trial recruited women aged 20-59 years with recent low-grade cervical cytology; women randomised to immediate referral for colposcopy were included in the current analysis (n = 2213). At trial recruitment, women completed a socio-demographic and lifestyle questionnaire; 1693 women in the colposcopy arm were also invited to complete a psychosocial questionnaire, including the Hospital Anxiety and Depression Scale. Women were sent up to two colposcopy appointments. A telephone number was provided to reschedule if necessary. Defaulters were defined as those who failed to attend after two appointments. Logistic regression methods were used to compute multivariate odds ratios (OR) to identify variables significantly associated with default.Results: 148 women defaulted (6.7%, 95%Cl 5.7-7.8%). In multivariate analysis, risk of default was significantly raised in those not in paid employment (OR = 2.70, 95%Cl 1.64-4.43) and current smokers (OR = 1.62, 95%Cl 1.12-2.34). Default risk deceased with increasing age and level of post-school education/training and was lower in women with children (OR = 0.59, 95%Cl 0.35-0.98). Among the subgroup invited to complete psychosocial questionnaires, women who were not worried about having cervical cancer were significantly more likely to default (multivariate OR = 1.56, 95%Cl 1.04-2.35).. Anxiety and depression were not significantly associated with default.Conclusions: Women at highest risk of default from colposcopy are younger, not in paid employment, smoke, lack post-school education, have not had children and are not worried about having cervical cancer. Findings such as these could inform the development of tools to predict the likelihood that an individual woman will default from follow-up. Interventions to minimise default also deserve consideration, but a better understanding of reasons for default is needed to inform intervention development. (C) 2012 Published by Elsevier Ireland Ltd.

AB - Objective: The success of cervical screening relies on women with abnormal cervical cytology attending for follow-up by colposcopy and related procedures. Failure to attend for colposcopy, however, is a common problem in many countries. The objective of this study was to identify factors associated with non-attendance at an initial colposcopy examination among women with low-grade abnormal cervical cytology.Study design: A cohort study was conducted within one arm of a multi-centre, population-based randomised controlled trial nested within the UK NHS Cervical Screening Programmes. The trial recruited women aged 20-59 years with recent low-grade cervical cytology; women randomised to immediate referral for colposcopy were included in the current analysis (n = 2213). At trial recruitment, women completed a socio-demographic and lifestyle questionnaire; 1693 women in the colposcopy arm were also invited to complete a psychosocial questionnaire, including the Hospital Anxiety and Depression Scale. Women were sent up to two colposcopy appointments. A telephone number was provided to reschedule if necessary. Defaulters were defined as those who failed to attend after two appointments. Logistic regression methods were used to compute multivariate odds ratios (OR) to identify variables significantly associated with default.Results: 148 women defaulted (6.7%, 95%Cl 5.7-7.8%). In multivariate analysis, risk of default was significantly raised in those not in paid employment (OR = 2.70, 95%Cl 1.64-4.43) and current smokers (OR = 1.62, 95%Cl 1.12-2.34). Default risk deceased with increasing age and level of post-school education/training and was lower in women with children (OR = 0.59, 95%Cl 0.35-0.98). Among the subgroup invited to complete psychosocial questionnaires, women who were not worried about having cervical cancer were significantly more likely to default (multivariate OR = 1.56, 95%Cl 1.04-2.35).. Anxiety and depression were not significantly associated with default.Conclusions: Women at highest risk of default from colposcopy are younger, not in paid employment, smoke, lack post-school education, have not had children and are not worried about having cervical cancer. Findings such as these could inform the development of tools to predict the likelihood that an individual woman will default from follow-up. Interventions to minimise default also deserve consideration, but a better understanding of reasons for default is needed to inform intervention development. (C) 2012 Published by Elsevier Ireland Ltd.

KW - colposcopy

KW - abnormal cervical cytology

KW - default

KW - non-attendance

KW - cervical screening

KW - PAP-smear

KW - health literacy

KW - adherence

KW - knowledge

KW - smoking

KW - anxiety

KW - adults

KW - cost

U2 - 10.1016/j.ejogrb.2012.08.001

DO - 10.1016/j.ejogrb.2012.08.001

M3 - Article

VL - 165

SP - 318

EP - 325

JO - European Journal of Obstetrics & Gynecology and Reproductive Biology

JF - European Journal of Obstetrics & Gynecology and Reproductive Biology

SN - 0301-2115

IS - 2

ER -