IMPROVING THE FOLLOW-UP OF PATIENTS WITH ABNORMAL PAPANICOLAOU SMEAR RESULTS

A review of the literature on adherence with recommended follow-up aft er an abnormal screening Papanicolaou smear result reveals that many w omen do not receive adequate follow-up. Primary care providers can inf luence the number of women who undergo timely colposcopy or a subseque nt Papanicolaou smear by addressing common barriers to follow-up. Phys icians should anticipate fears commonly experienced by women when they learn of abnormal Papanicolaou smear results, including fear of cance r,fear of pain during colposcopy, and fear of loss of sexual or reprod uctive function. An awareness that certain populations are at especial ly high risk of inadequate follow-up, including black and Hispanic wom en, women with less than a high school education, and women of low soc ioeconomic status, can help physicians target their efforts. Practical strategies for improving follow-up include speaking directly with the patient about results, emphasizing the precancerous nature of most le sions, actively preparing the patient for colposcopy by describing the procedure and its complications, and addressing fears about the commo n treatment options for cervical intraepithelial neoplasia. Office-bas ed reminder systems and educational materials may also be used as adju ncts to personal contact.