Women's understanding of a "normal smear test result": experimental questionnaire based study

Objectives To describe women's understanding of a negative smear test resul t when presented using the term "normal smear result," as required by the N HS cervical screening programme, and to evaluate the impact on understandin g of different ways of presenting the residual risk inherent in such a resu lt. Design Experimental questionnaire based study. Interventions Participants were asked to imagine that they had received a n ormal smear result The meaning of this result was then presented using diff erent combinations of three different expressions of residual risk of havin g or developing cervical cancer over the next five years: a verbal probabil ity of absolute risk (low risk), a numerical probability of absolute risk(1 in 5000), or a numerical probability of risk relative to an unscreened wom an (five times lower). Participants: 1027 women aged 20 to 64. Results When informed only that their smear result was normal, 52% (80 of 1 53 women) of participants correctly understood that this entailed a residua l risk of cervical cancer, compared with 70% (107 of 152) given the additio nal sentence explaining the meaning of a normal smear result using a verbal probability of absolute risk (difference 18%; 95% confidence interval 7% t o 29%). Additionally: explaining the results using a numerical probability of absolute or relative risk did not increase the proportion who correctly understood that there was a residual risk of cervical cancer. Conclusions NHS policy for reporting normal smears needs to change to make it a definite requirement that the reporting of a "normal smear result" is accompanied by a sentence stating that this means a low risk for having or developing cervical cancer in the next five years.