Interventions for reducing anxiety in women undergoing colposcopy

Background

Before cervical cancer develops the cells of the cervix become abnormal. Following an abnormal cervical smear colposcopy is performed. Colposcopy is the visualisation of the cervix using a binocular microscope. Women experience high levels of anxiety and negative emotional responses at all stages of cervical screening. High levels of anxiety before and during colposcopy can have adverse consequences, including pain and discomfort during the procedure and high loss to follow-up rates. This review evaluates interventions designed to reduce anxiety levels during colposcopic examination.

Objectives

To compare the efficacy of various interventions aimed at reducing anxiety during colposcopic examination in women.

Search strategy

The Cochrane Central Register of Controlled Trials (CENTRAL), (Cochrane Library, Issue 1, 2006) MEDLINE (1951-2006), EMBASE (1980-2006), CINAHL (1982-2006), Psych Lit and CancerLit, NHMRC Clinical Trials Register, UKCCCR Register of Cancer Trials, Meta-Register and Physician Data Query Protocols.

Selection criteria

Randomised and quasi randomised controlled trials of interventions to reduce anxiety during colposcopic examination.

Data collection and analysis

One author searched the citations and reference lists. Studies that appeared to meet inclusion criteria were retrieved and assessed independently by the remaining three authors. The methodological quality of included studies was assessed using the Cochrane Collaboration Back Review Group's methodological quality criteria (van Tulder 2003).

Main results

Eleven trials were included, these trials used various interventions to reduce anxiety. These examined 1441 women's anxiety levels after different types of intervention. These included:

Information leaflets - (proved not to be associated with anxiety reduction).
Counselling: pre-colposcopic counselling was not associated with anxiety reduction.
Information leaflets and information video and pre-colposcopy counselling was not associated with a reduction in anxiety levels.
Listening to music during colposcopy: this intervention was associated with reduction in anxiety levels (p < 0.002).
Video colposcopy was associated with reduction in anxiety levels, and the reduction in anxiety was significant (p < 0.0002).
Information using graphs and verbal information and information video versus information only when sought: There was no significant reduction in the level of anxiety in the intervention group.
Information leaflets and information video versus information leaflets only: There was a reduction in anxiety levels in the intervention group compared to the control group (p < 0.00001).

Authors' conclusions

Anxiety appears to be reduced by playing music during colposcopy, showing information videos prior to colposcopy and viewing video colposcopy during the procedure. Although information leaflets did not reduce anxiety levels, they did increase knowledge levels and so are useful in obtaining clinical consent to the colposcopic procedure.