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Effect of professional society recommendations on women’s desire for a routine pelvic examination

      Background

      The American College of Physicians strongly recommends against performing pelvic examinations in asymptomatic, nonpregnant women, citing evidence of harm (false-positive testing, unnecessary surgery) and no evidence of benefit. In contrast, the American Congress of Obstetricians and Gynecologists recommends pelvic examinations in asymptomatic women beginning at age 21 years, citing expert opinion.

      Objective

      We sought to evaluate if providing women with professional societies’ conflicting statements about pelvic examinations (recommendations and rationales) would influence their desire for a routine examination.

      Study Design

      We recruited 452 women ages 21-65 years from 2 women’s clinics to participate in a 50-minute face-to-face interview about cervical cancer screening that included a 2-phase study related to pelvic examinations. In the first phase, 262 women were asked about their desire for the examination without being provided information about professional societies’ recommendations. In the second phase, 190 women were randomized to review summaries of the American College of Physicians or American Congress of Obstetricians and Gynecologists statement followed by an interview.

      Results

      First-phase participants served as the referent: 79% (208/262) indicated they would want a routine examination if given a choice. In the second phase, a similar percentage of women randomized to the American Congress of Obstetricians and Gynecologists summary had this desire (82%: 80/97; adjusted odds ratio, 1.37; 95% confidence interval, 0.69–2.70). Women randomized to the American College of Physicians summary, however, were less likely to indicate they would opt for an examination (39%: 36/93; adjusted odds ratio, 0.12; 95% confidence interval, 0.06–0.21). Overall, 94% (179/190) believed the potential benefits and harms should be discussed prior to the examination.

      Conclusion

      Providing women with a professional society’s recommendation advising against routine pelvic examinations substantially reduced their desire to have one. Educational materials are needed to ensure women’s informed preferences and values are reflected in decisions about pelvic examinations.

      Key words

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      References

      1. National Center for Health Statistics, Centers for Disease Control and Prevention. National Ambulatory Medical Care Survey: 2012 state and national summary tables. Available at: http://www.cdc.gov/nchs/data/ahcd/namcs_summary/2012_namcs_web_tables.pdf. Accessed Jan. 17, 2017.

        • Sawaya G.F.
        Pelvic examinations in asymptomatic women: tipping a sacred cow.
        Arch Intern Med. 2011; 171: 2054-2055
        • Sawaya G.F.
        • Jacoby V.
        Screening pelvic examinations: right, wrong, or rite?.
        Ann Intern Med. 2014; 161: 78-79
        • Henderson J.T.
        • Harper C.C.
        • Gutin S.
        • Saraiya M.
        • Chapman J.
        • Sawaya G.F.
        Routine bimanual pelvic examinations: practices and beliefs of US obstetrician-gynecologists.
        Am J Obstet Gynecol. 2013; 208: 109.e1-109.e7
        • Westhoff C.L.
        • Jones H.E.
        • Guiahi M.
        Do new guidelines and technology make the routine pelvic examination obsolete?.
        J Womens Health (Larchmt). 2011; 20: 5-10
        • Qaseem A.
        • Humphrey L.L.
        • Harris R.
        • Starkey M.
        • Denberg T.D.
        Clinical Guidelines Committee of the American College of Physicians. Screening pelvic examination in adult women: a clinical practice guideline from the American College of Physicians.
        Ann Intern Med. 2014; 161: 67-72
        • Bloomfield H.E.
        • Olson A.
        • Greer N.
        • et al.
        Screening pelvic examinations in asymptomatic, average-risk adult women: an evidence report for a clinical practice guideline from the American College of Physicians.
        Ann Intern Med. 2014; 161: 46-53
        • Committee on Gynecologic Practice
        Well-woman visit. Committee opinion no. 534.
        Obstet Gynecol. 2012; 120: 421-424
      2. Bernstein L. To your health: Healthy women do not need routine pelvic exams, influential physicians group says. Washington Post. June 30, 2014. Available at: https://www.washingtonpost.com/news/to-your-health/wp/2014/06/30/healthy-women-do-not-need-routine-pelvic-exams-influential-physicians-group-says/. Accessed Jan. 17, 2017.

        • Conry J.A.
        • Brown H.
        Well-woman task force: components of the well-woman visit.
        Obstet Gynecol. 2015; 126: 697-701
        • Norrell L.L.
        • Kuppermann M.
        • Moghadassi M.N.
        • Sawaya G.F.
        Women's beliefs about the purpose and value of routine pelvic examinations.
        Am J Obstet Gynecol. 2016 Dec 28; (pii: S0002-9378(16)46290-3. http://dx.doi.org/10.1016/j.ajog.2016.12.031. [Epub ahead of print])
        • Guirguis-Blake J.M.
        • Henderson J.T.
        • Perdue L.A.
        Periodic screening pelvic examination: evidence report and systematic review for the US Preventive Services Task Force.
        JAMA. 2017; 317: 954-966
      3. US Preventive Services Task Force. Final recommendation statement gynecological conditions: screening with the pelvic examination. Available at: https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/gynecological-conditions-screening-with-the-pelvic-examination. Accessed April 15, 2017.

        • Petitti D.B.
        • Teutsch S.M.
        • Barton M.B.
        • et al.
        Update on the methods of the US Preventive Services Task Force: insufficient evidence.
        Ann Intern Med. 2009; 150: 199-205
      4. American Congress of Obstetricians and Gynecologists. Practice advisory: screening pelvic examination. Available at: http://www.acog.org/About-ACOG/News-Room/Practice-Advisories/Practice-Advisory-Screening-Pelvic-Examination. Accessed Jan. 17, 2017.

        • Sawaya G.F.
        Screening pelvic examinations: the emperor's new clothes, now in 3 sizes?.
        JAMA Intern Med. 2017; 177: 467-468