WOMENS TRIAGE AND MANAGEMENT PREFERENCES FOR CERVICAL CYTOLOGIC REPORTS DEMONSTRATING ATYPICAL SQUAMOUS CELLS OF UNDETERMINED SIGNIFICANCE AND LOW-GRADE SQUAMOUS INTRAEPITHELIAL LESIONS

Objective: To determine women's triage test preferences for the evalua tion and management of atypical squamous cells of undetermined signifi cance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL) Pap anicolaou smear reports.Design: A 35-item questionnaire. Setting: Prim ary care clinic waiting rooms. Participants: A convenience sample of 9 68 women. Intervention: Women received standardized descriptions of th e meaning of ASCUS and LSIL Papanicolaou smear classifications and uni form descriptions of the 4 triage tests: Papanicolaou smear, human pap illomavirus DNA test, cervicography, and colposcopy. Main Outcome Meas ures: Subjects' responses to questionnaire. Results: More women (58.4% ) preferred a repeat Papanicolaou smear for an ASCUS report than would choose human papillomavirus DNA testing (7.3%), cervicography (20.6%) , or colposcopy (13.8%) (P<.001, chi(2)) Alternatively, 51% of women w anted colposcopy to evaluate an LSIL report compared with the other 3 options (P<.001, chi(2)). Test accuracy was the most important factor that influenced women's decisions for each test, compared with cost, d iscomfort, and other reasons (P<.001, chi(2)) Positive predictors for women's selection of colposcopy to evaluate a Papanicolaou smear showi ng LSIL included older age (P<.01, logistic regression analysis), high er level of income (P<.001, chi(2)), greater level of education (P<.00 1, logistic regression analysis),greater level of knowledge of colposc opy and Papanicolaou smears (P<.001, logistic regression analysis), fa mily history of cervical cancer (P<.01, chi(2)), and history of cervic al dysplasia (P=.02, chi(2)). Conclusions: Most women preferred a repe at Papanicolaou smear to further evaluate an initial Papanicolaou smea r demonstrating ASCUS and colposcopy to evaluate a report of LSIL. Wom en identified test accuracy as the most important reason for triage te st selection. Multiple factors, primarily involving patient and family history of cervical neoplasia, level of education, income, age, and k nowledge of tests, influence women's desire for specific triage tests. Because no optimal management of women with AS CUS and LSIL Papanicol aou smear reports has been determined, consideration of cr omen's tria ge test preferences should complement overall patient care.