1. Women’s differing experiences of distress following colposcopy & related procedures: a qualitative interview study
Mairead O’Connor1, Jo Waller2, Pamela Gallagher3, John O’Leary4, Cara Martin4, Linda Sharp1
1National Cancer Registry Ireland; 2UCL, London; 3DCU, Dublin; 4Coombe Women & Infants University Hospital, Dublin

2. Background Undergoing colposcopy can be distressing for some women
Accumulating evidence that colposcopy and related procedures are associated with psychological after-effects
Lack of understanding about what drives - or protects women against - colposcopy related distress

3. Aims In women who underwent colposcopy +/- related procedures:
examine women’s differing experiences of psychological distress;
explore what is associated with, or protects against psychological distress

4. Methods Women who had previously attended for colposcopy
took part in a longitudinal psychological survey
sampled for heterogeneity; women with a range of psychological outcomes and from different martial status groups
In-depth qualitative interviews conducted January - June 2013
Interviews audio-recorded, transcribed verbatim, anonymised & analysed using the Framework Approach

5. Participants 23 participants Heterogeneous SES characteristics
women aged yrs
16 married/cohabiting, 4 single (in a relationship), 2 single (not in relationship), 1 widowed
11 had higher 3rd level education, 3 lower 3rd level (certificate/diploma level), 9 < 3rd level education
14 had children, 9 had no children
A range of different initial colposcopy results

6. Women’s psychological responses after colposcopy
Short-term distress
Long-term distress
Both short-& long-term distress
No distress
Short-term distress
Distressed immediately after colposcopy or in the days that followed
Distress related to physical experience of colposcopy
Long-term distress
For some, these concerns dissipated over time; for others they persisted
Concerns about longer-term issues like fertility, cervical cancer & having sex

7. What was associated with short-term distress
Attending the clinic alone
Feeling unprepared for the procedure
Negative experience of the procedure
Feeling unprepared for
the procedure:
“I felt if I’d known that [would be having biopsy taken] in advance I would have been more prepared whereas, it kind of took me by surprise & I got quite upset because I hadn’t been expecting it”

8. What was associated with long-term distress
Intending to have (more) children
Having physical after-effects that impacted on them
Being under continued clinic surveillance
Intending to have (more) children: “If I got cervical cancer I wouldn’t be able to have children or it would be hard. it was just so important to me to have another child, to have any obstacle in the way of that was very stressful”

9. What protects against distress
Finding the procedure [colposcopy] not as bad as anticipated:
“I was expecting worse. So when I actually went to have it done, I was like ‘this is nothing’, that’s the way I felt. It was no big deal”
Short-term distress
Being accompanied to the clinic
Feeling well prepared for the procedure
Finding the procedure not as bad as anticipated
Long-term distress
Having been discharged from the clinic
Not having phy. after-effects that impacted on them
Not intending to have (more) children
Having been discharged from the clinic: “I was delighted she [nurse] said everything was all clear and that they were going to discharge me..I was thrilled that it wasn’t developing into something more serious and I was finished [with clinic]”

10. Conclusions
Colposcopy can lead to short- and long-term post-procedural distress for some women
Certain things may help protect against colposcopy related distress
The findings could help inform strategies to minimise psychological after-effects of follow-up for abnormal cervical cytology
What next?
Develop an appropriate theory based psycho-educational intervention to alleviate distress in women undergoing colposcopy & related interventions

11. Acknowledgements Further information: m.oconnor@ncri.ie www.cerviva.ie
We thank the women who took part in the interview study
We are grateful to the clinicians and staff at the Coombe Women & Infants University Hospital and the National Maternity Hospital, Dublin
Further information:
This work is funded by the Health Research Board