This study aimed to investigate the extent of psychological distress in patients with abnormal Pap smears and the factors that influence this distress.
We were able to demonstrate that nearly 60,0% of the patients already experience psychological distress during their initial visit to our special dysplasia consultation hour at the Department of Obstetrics and Gynecology (University of Wuerzburg). In 2020, Jentschke et al. conducted a survey concerning the mental state of over 2000 women, who had to attend follow-up appointments over an extended period due to abnormal Pap smears. For many women, the uncertain situation with prolonged waiting times between appointments caused significant distress. The proportion of psychologically distressed individuals was 70,0%, which aligns with the findings of our study [10]. This is a considerable percentage, taking into consideration that an abnormal Pap smear affects several million women annually in Germany. It underscores the importance of comprehensive education and providing informational materials.
When considering the age of the affected women it is noteworthy that many women experience abnormal findings at a young age. In 2020, one-third of new cases of cervical carcinoma occurred in women under 44 years of age [11]. In the analysis of the collected questionnaire data, half of the patients with abnormal Pap smears were younger than 44 years old. As expected, the younger group of patients, especially those with concerns about fertility and sexuality, experiences greater distress. These results are consistent with the findings of Jentschke et al. in 2020, which indicated that abnormal Pap smears particularly lead to high distress and affect family planning for women with existing fertility desires.
Regarding information acquisition according to age, both groups primarily obtained information from their gynecologist. However, the internet played a more important role as an information source for the younger group, which may lead to a higher risk of misinformation [12].
Based on the education distribution, it can be observed that patients with lower education levels generally experience higher distress. However, as seen above, the younger, better-educated group of women exhibited higher average psychological distress than the older patients.
Overall, over 40% of patients reported feeling poorly informed. This is a substantial portion, considering that patients had already been informed about the abnormal findings by their gynecologist. Patients are further referred to the clinic and have the opportunity to gather additional information before their visit to our consultation hour. This raises two questions: Can a more comprehensive education potentially improve patients' knowledge and thereby reduce psychological distress? And is there a lack of necessary informational materials that patients can review by themselves at home? As mentioned in the introduction, despite the national HPV vaccination campaign and increased availability of information and education, many patients still find the provided information inadequate [12].
It should be acknowledged that variations in patient education by their respective physician can affect patient knowledge. When examining the information available on the internet, it becomes clear that most health insurance companies highlight key points about screening on their websites and brochures from the Joint Federal Committee (Gemeinsamer Bundesausschuss) are also available. The brochure from the Joint Federal Committee contains all the necessary information regarding early detection, basic information on cervical carcinoma, the procedure of examinations, and the significance of examination results. Additionally, it explains the pros and cons of early detection. These brochures are available for free download. A study conducted in the USA in 1993 demonstrated the effect of targeted information and education regarding abnormal Pap smears before a clinic visit. Patients in this study were given the choice of receiving informational materials before their appointment. Those who received the materials reported significantly less concern about the abnormal Pap smear and the risk of cancer in subsequent questionnaires compared to the cohort which did not receive the materials [13]. Another study conducted in 1994 provided evidence that patients who received informational brochures were significantly more likely to attend follow-up appointments after abnormal Pap smears compared to those who did not receive informational materials [14]. The desire for more information is evident, with over 50% of patients wishing for more information before their visit. Furthermore, since over 68% of patients primarily obtain information from their gynecologist, with the internet being the second most common source, it underscores the importance of the doctor-patient relationship.
Taken together, we can summarize that patients who obtained information from the internet reported feeling less informed, had a greater desire for information before their visit, and experienced greater distress. These results, coupled with the fact that the gynecologist remains the primary source of information for patients, emphasizes how crucial adequate education and the provision of informational materials from treating doctors are.