Patient Education and Counseling

The influencing factors in intention making-decision of Human papillomavirus vaccine in Chinese college students: A qualitative study

College students are considered as a high-risk age group for contracting HPV. HPV vaccines are proved to play a major role in preventing Cervical cancer and related cancers among both men and women. This study aimed to explore influencing factors in intention making-decision of Human papillomavirus vaccine in Chinese college students. A descriptive qualitative research based on naturalistic inquiry in Daqing City, Heilong Jiang Province from October to November 2022 was conducted. Semi-structured interviews with Chinese college students. We used thematic framework analysis with NVivo 12.0 software to transcribe and analyze the interview recordings. We conducted 20 in-depth interviews. Four main themes with 14 subthemes were identified: (a) potential risks of HPV infection; (b) susceptibility factors of HPV infection; (c) difficulties in HPV vaccination; (d) decision support for HPV vaccination. Most college students expressed hesitancy toward receiving the HPV vaccine. The government should strengthen the advocacy of the benefits of the vaccine to increase the HPV vaccination rate. Healthcare providers and the government should take some strategies to promote facilitate factors to increase HPV vaccination rates.

“A great step in treating cervical cancer”: Patient and provider perceptions about cervical cancer therapeutic vaccines

This study explored patients and providers' perspectives on therapeutic vaccines for cervical cancer and assessed barriers and facilitators. Qualitative semi-structured in-depth interviews were conducted with patients who had cervical dysplasia, or a past or current cervical cancer diagnosis and providers who provided care to patients with cervical abnormalities or cervical cancer. Data were analyzed using thematic analysis in NVivo. A total of 28 in-depth interviews were conducted with patients (N = 15) and providers (N = 13). Participants in both groups expressed enthusiasm for the prospect of a therapeutic vaccine for cervical cancer and were encouraged by less invasive treatment opportunities. Perceived patient barriers included concerns about side effects, eligibility criteria, costs, transportation, and logistical obstacles. Providers echoed these concerns, highlighted additional structural barriers such as racism and limited availability of culturally sensitive educational aids, and underscored the need for provider training on this topic. Our results reinforce the need for future multi-level interventions discussing vaccine efficacy, durability, and safety, as well as addressing factors such as awareness, knowledge, and beliefs. Our findings can contribute to the development of provider and patient-centered tools that promote therapeutic vaccine acceptance.

Relationships among health-related social media use, knowledge, worry, and cervical cancer screening: A cross-sectional study of US females

This study aimed to explore the relationship between health-related social media use and HPV-related health knowledge, attitudes, and practices (KAP). Data were derived from a subset of the national cohort from the 2022 Health Information National Trends Survey (HINTS 6), including only women aged 21 to 65 years old (n = 2013). Ordinary least squares regression and structural equation modeling were used to answer the research question and test hypotheses. Participants with a family history of cancer, higher education, and White showed more HPV knowledge. Older females were associated with lower HPV knowledge, less worry and fewer timely cervical cancer screening. Additionally, HPV knowledge positively predicted worry and cervical cancer screening. Health-related social media use positively predicted HPV knowledge, worry, and cervical cancer screening. This study identified populations with HPV knowledge and hesitated cervical cancer screening and tested hypothesized models that combine social media use with the KAP survey. Future health interventions should strategically leverage the role of social media to enhance public awareness of HPV knowledge and cancer concerns. By promoting HPV knowledge and awareness, such interventions can subsequently encourage timely cervical cancer screening.

The potential influence of patient-centered communication, online provider communication, and social determinants of health on cancer screening

To understand how breast and cervical cancer screening are influenced by communicating with a healthcare provider, patient activation, and social determinants of health. Data were from the National Cancer Institute's Health Information National Trends Survey, focusing on women with no history of cancer at least 21 years old (N = 1466) to study cervical cancer screening and those at least 40 years old (N = 1114) to study breast cancer screening. Variables included patient-centered communication, electronic healthcare communication, patient activation, race/ethnicity, education, health insurance status, Appalachian residence, and financial insecurity. Electronic communication predicted both cancer screens, but especially for White women. Patient-centered communication influenced cervical cancer screening only for women with insurance. It only influenced mammography for those without insurance. Patient activation did not influence either cancer screen behavior. These data demonstrate more nuance is needed to parse potential effects of advocated-for healthcare behaviors. Use of publicly available datasets from can be informative but are limited methodologically. Healthcare providers and systems should promote use of patient portals and other electronic means of interaction outside regular clinical visits for all patients. However, attention needs to be paid to the unequal benefits they afford to patients.

Effects of a pre-visit online information tool about genetic counselling for ovarian cancer patients, a randomized controlled trial

In the Netherlands, patients with ovarian cancer are offered genetic testing. Pre-test preparation may help counseling patients. The aim of this study was to determine if use of a web-based intervention, leads to more effective genetic counseling of ovarian cancer patients. Between 2016 and 2018, 127 ovarian cancer patients referred for genetic counseling in our hospital participated in this trial. 104 Patients were analyzed. All patients filled out questionnaires pre- and post-counseling. The intervention group also completed a questionnaire after visiting an online tool. Length of consultation, patients' satisfaction, knowledge, anxiety, depression and distress were compared before and after counselling. The intervention group had the same level of knowledge compared to the counseling group, but at an earlier point in time. They were satisfied with the intervention (86%) and better prepared for counseling (66%). The intervention did not lead to shorter consultations. No differences in levels of anxiety, depression, distress and satisfaction were observed. Although consultation length was unaffected, the improvements in knowledge after online education and patients satisfaction indicates that this tool can be an effective addition to genetic counseling. Use of an educational tool may lead to a more effective, personalized way of genetic counselling and enables shared decision making.

An intervention to increase cervical cancer screening among women living with HIV: A mixed methods study

We examined the effectiveness of a behavioral intervention in promoting cervical cancer screening among women living with HIV (WLWH) in Ghana. A Mixed-methods study was conducted involving 83 WLWH, who were randomly assigned to an intervention group (n = 42) to receive voice-recorded messages based on the 3 R model (Reframing, Reprioritizing, and Reforming) or a control group (n = 41) to receive standard care. The primary outcomes were screening uptake and HPV prevalence. Other outcomes were the acceptability, appropriateness, and feasibility of the intervention. The intervention group had a 100% screening rate, and the control group had a 14.63% screening rate. The prevalent rate of high-risk (hr)-HPV genotypes among the women was 67.5% (95%C.I: 0.56-0.77). Over 48% of the participants had multiple hr-HPV genotypes, 64.29% had HPV16/18/45%, and 73.21% had HPV 31/33/45/52/58. Of the women (89.30%) who screened positive, 60% of them were diagnosed and treated for pre-cancer lesions. The intervention messages were acceptable (encourage proactive behavior), feasible (simple, easy to understand), and appropriate (helpful, informative). Facilitators and barriers to self-sampling were identified. Combining the 3 R model with self-sampling increases cervical cancer screening among WLWH. Healthcare professionals and policymakers can use this model to increase cervical cancer screening.

Confusion and anxiety in between abnormal cervical cancer screening results and colposcopy: “The land of the unknown”

Attendance to colposcopy after abnormal cervical cancer screening is essential to cervical cancer prevention. This qualitative study explored patients' understanding of screening results, their experiences of the time leading up to the colposcopy appointment, and colposcopy. We recruited women referred for colposcopy from two urban practices in an academic health system. Individual interviews (N = 15) with participants were conducted after colposcopy appointments about their cervical cancer screening histories, current results, and colposcopy experiences. A team analyzed and summarized interviews and coded transcripts in Atlas.ti. We found that most women were confused about their screening results, did not know what a colposcopy was before being referred for one, and experienced anxiety in the interval between receiving their results and having their colposcopy. Most women searched for information online, but found "misinformation," "worst-case scenarios" and generic information that did not resolve their confusion. Women had little understanding of their cervical cancer risk and experienced anxiety looking for information and waiting for the colposcopy. Educating patients about cervical precancer and colposcopy, providing tailored information about their abnormal screening test results and potential next steps, and helping women manage distress may alleviate uncertainty while waiting for follow-up appointments. Interventions to manage uncertainty and distress in the interval between receiving an abnormal screening test result and attending colposcopy are needed, even among highly adherent patients.

Training courses on hereditary breast and ovarian cancer to strengthen cross-sectoral care in underserved areas

To strengthen cross-sectoral care by disseminating specialized knowledge about hereditary breast and ovarian cancer across underserved areas. We report on a training course about genetic counseling and testing of hereditary breast and ovarian cancer patients for gynecologists from certified cancer centers. In total, 50 gynecologists attended the course which was offered once annually between 2017 and 2019. Before and after the course, participants were asked to answer a self-assessment questionnaire and completed the training with a multiple-choice test. The results of the self-assessments and knowledge tests were analyzed to steadily improve the training. The self-assessments imply a perceived increase in certainty regarding the inclusion criteria for specialized genetic counseling, pedigree analysis, and contents of the initial consultation. Both the knowledge tests and self-assessments showed that participants had difficulties in interpreting and differentiating between age-specific and lifetime risks. The courses successfully conveyed knowledge necessary to identify patients at risk and to provide timely genetic analyses even in rural areas. The results are a promising basis for creating additional training courses addressing specialists in hospitals and gynecological practices. Further education of physicians might improve cross-sectoral cooperation and thereby enable specialized care supply in rural areas.

Impact of educational video on cervical cancer knowledge in hispanic patients: A randomized trial

To evaluate the impact of a cervical cancer screening and prevention educational video on patient knowledge and appointment satisfaction. An educational video focused on cervical cancer screening and prevention was created. Individuals who self-identified as Hispanic/Latina and planned to receive a Pap smear during their office visit were invited to participate. The control arm received standardized physician-only counseling and the intervention arm received physician counseling in addition to an educational video. Participants completed a pre and post-test knowledge survey. Two hundred and fourteen patients met inclusion criteria, and 192 patients underwent randomization and completed the study. Ninety-seven patients were enrolled in the control arm and 95 patients in the intervention arm, with no differences in baseline characteristics between groups. Knowledge scores improved significantly in both groups; however, the intervention group had a larger increase in knowledge scores (2.91 points, p < 0.001) than the control group (0.59, p < 0.001). Patients in the intervention arm had improvement in 7/10 questions, while patients in the control arm had improvement in 2/10 questions. Using multivariate analysis, higher post-visit knowledge scores were independently associated with the intervention arm, higher pre-visit knowledge scores, and increased education. Knowledge gaps contribute to reduced cervical cancer screening adherence. Our study demonstrates the effectiveness of an educational video in significantly increasing knowledge regarding cervical cancer in primarily Spanish-speaking Hispanic patients. The use of an educational video on cervical cancer screening and prevention significantly improves patient knowledge, particularly in Spanish-speaking Hispanic patients, and can be an effective tool for enhancing adherence to screening guidelines. NCT05756192 Study Details | Educational Video's Impact on Knowledge Regarding Cervical Cancer Screening | ClinicalTrials.gov CLINICAL TRIAL INFORMATION: Registered to clinicaltrials.gov on Jan 1,2023 under protocol ID NCR224166.

Content and quality of consumer websites providing information about human papillomavirus infection in patients with systemic lupus erythematosus: An environmental scan

We aimed to evaluate the content and quality of websites for consumers providing information about human papillomavirus (HPV) risks in patients with systemic lupus erythematosus (SLE). We conducted an environmental scan of websites for patients and the general public with information about HPV and SLE. We searched Google from inception to June 2023, using the terms "HPV" and "lupus". We included websites with information about HPV and SLE. Two reviewers appraised the websites and collected website characteristics, and rated various attributes: completeness and comprehensiveness, accuracy, technical elements, design and aesthetics, usability, readability, and accessibility. We identified 16 websites for analysis. Ten (62.5 %) were commercial websites One website provided complete and comprehensive information about HPV risk, screening, and vaccination in patients with SLE; 7 (44 %) websites provided only information about the HPV vaccine. Eight websites included risk of HPV infection, cervical cancer screening, and cervical cancer risk in patients with SLE. Seventy-five percent provided information based on clinical guidelines, textbooks, peer-reviewed papers or scientific publications while the remaining were based on expert opinions. All websites were considered to have adequate design and aesthetics and were easy to navigate. Only 1 (6 %) website had a 6th-grade reading level and the other had reading levels higher than that (not appropriate for consumer websites). The overall quality scores ranged from 32 to 51 (maximum 69). Our findings showed that most websites for patients and the general public with information about HPV and SLE did not provide complete and comprehensive information about HPV.

What matters most: A Q-methodology study of the viewpoints of women diagnosed with a BRCA gene mutation on person-centred care

Women diagnosed with BRCA mutations face elevated risks of breast and ovarian cancer. Managing inherited risk involves complex, value-laden decisions, yet health services frequently overlook the distinct challenges these women encounter. Person-centred care (PCC) may complement medical management by addressing what matters most to patients. To inform PCC delivery for women diagnosed with BRCA, this study examined which care aspects women themselves prioritize in their trajectory and how perspectives vary within this population. We applied Q-methodology to investigate the perspectives of 23 cancer-unaffected, female BRCA carriers in the Netherlands. Participants ranked statements reflecting PCC principles by personal importance, and elaborated on their choices in interviews. Factor analysis with varimax rotation identified shared viewpoints, which were interpreted using factor arrays and enriched with qualitative data. Three distinct viewpoints were identified, explaining 51 % of the data variance: (1) 'The Informed Journey' in which women prioritized comprehensive information to enable decision-making; (2) 'Care Rooted in Compassion' whereby women emphasized the importance of empathic, respectful interactions in building trust; and (3) 'Acknowledging Intimacy and Loss' in which women prioritized clinicians' attention to the embodied impacts of their care trajectory, including reproductive and post-surgical or menopausal challenges. Our findings support the relevance of person-centred approaches in care for women living with genetic cancer risk. Women with BRCA mutations differ in what they value most in their care, yet shared priorities emerge. Understanding whether a woman emphasises information, compassion, or bodily concerns can guide clinicians in tailoring communication and counselling. Such alignment helps ensure that risk management strategies are inherently responsive to women's lived experiences and support their broader well-being.

The role of perceived stress in the relationship between sexual communication, health literacy, and quality of life in women diagnosed with cervical cancer

This study aimed to examine the relationships between sexual communication self-efficacy, health literacy, perceived stress, and QoL in women with CC before the initiation of the proper treatment. The study was conducted at the Oncology Center involving 60 women aged 40-65 with stage II-III CC undergoing radiotherapy or brachytherapy. Participants completed the 36-item Short Form Survey (SF-36) for QoL, the Female Sexual Function Index (FSFI), the Sexual Communication Self-Efficacy Scale (SCSES), the European Health Literacy Survey Questionnaire (HLS-EU-Q16), and the Perceived Stress Scale (PSS-10). Sexual communication self-efficacy was positively related to all QoL components (r = {0.458; 0.713}; p < 0.001). Health literacy significantly impacted sexual functioning (F(2) = 6.003; p = 0.004), but not physical or psychological functioning. Perceived stress negatively influenced all QoL components (r = {-0.402; -0.662}; p < 0.001) and mediated the relationships between sexual communication self-efficacy, health literacy, and QoL. SEM confirmed the model fit (CMIN/df = 1.558; TLI = 0.964; IFI = 0.978; CFI = 0.997; RMSEA = 0.097). These findings emphasize the significance of holistic care approaches that integrate psychological, social, and biological factors to enhance the QoL for women undergoing cancer treatment. Early psychological interventions that focus on stress reduction, communication skills, and improving health literacy could be integrated into prehabilitation programs for women with cervical cancer. Such interventions may strengthen patients' coping resources, improve sexual health, and promote better quality of life throughout the treatment trajectory.

A theory-based educational intervention to increase mothers’ intention to vaccinate their daughters against human papillomavirus: A randomised controlled trial

The current study aimed to examine the effectiveness of a web-based educational intervention based on the theory of planned behaviour (TPB) in enhancing mothers' knowledge of human papillomavirus (HPV) and its vaccine, attitudes towards the HPV vaccine, subjective norms, perceived behavioural control, and intention to vaccinate their daughters against HPV. A randomised controlled trial was conducted. The sample comprised 214 mothers of adolescents from 10 intermediate schools in Saudi Arabia. After collecting baseline data, the participants were randomly assigned to control and intervention groups. The TPB-based intervention was delivered online to the intervention group, and post-test data were collected from both groups. A mixed-effects model of covariance was used to test the effect of the intervention. There were no significant differences between the two groups at baseline. One month after delivery, the intervention was found to have a significant effect on mothers' knowledge (F (1, 211.15) = 72.40, p < .001), attitudes (F (1, 211.11) = 110.57, p < .001), subjective norms (F (1, 211) = 34.55, p < .001), perceived control behaviour (F (1, 211.12) = 144.01, p < .001), and intention to vaccinate their daughters against HPV (F (1, 211.05) = 113.64, p < .001). The study showed that the web-based intervention based on the TPB was effective in increasing mothers' knowledge, attitude, subjective norms, perceived control behaviour, and intention to vaccinate their daughters after 1 month. The findings underscore the significance of popularising and implementing such interventions to boost HPV vaccine coverage among adolescents.

Gynecological cancer patients share insights for better shared decision-making

To examine gynecological cancer patients' preferred role in decision making, their experienced involvement, and their advice to patients and clinicians on preparing for and supporting SDM in clinical consultations. Two validated questionnaires, the Control Preference Scale (CPS) and CollaboRATE, were used to assess patients' preferred roles in SDM and their perceived level of involvement in medical decisions. Two open-ended questions were included to gather descriptive advice from patients, intended for both patients and clinicians. The sample for this survey was drawn from participants in a Danish patient advocacy group. In total, 117 patients completed the CPS, with 90% (n = 105) indicating a preference for an active role and 10% (n = 12) indicating a preference for a collaborative role in decision making. Mean item scores for CollaboRATE (n = 114) were 6.6 (SD = 2.1) for explanation, 5.2 (SD = 2.6) for preference elicitation, and 5.5 (SD = 2.5) for integration, with 7.9% of the respondents giving a top score. The most repeated theme of advice to patients was to ask questions. Empathic communication, including active listening and the provision of clear, easy-to-understand information, was the most frequently emphasized advice to clinicians. Patients with gynecological cancer express a strong desire for involvement in SDM; however, many report that their experienced level of participation falls short of their preferences. They recommend an active role by asking targeted questions, thoroughly understanding benefits and risks of options, and remaining persistent in expressing needs. Patients emphasized the importance of empathetic communication, active listening, and the provision of clear, easy-to-understand information by clinicians. Our findings offer actionable recommendations to bridge the gap between patients' preferred role in SDM and their actual experiences across the care journey. By incorporating these recommendations, both patients and clinicians can adopt practical strategies to facilitate more personalized, patient-centered decisions aligned with individual preferences and needs.

Predictors of knowledge and knowledge gain after decision aid use among women with BRCA1/2 pathogenic variants

Developing a Collaborative Agenda-Setting Intervention (CASI) to promote patient-centered communication in ovarian cancer care: A design thinking approach

Patient-centered communication (PCC) occurs when clinicians respond to patients' needs, preferences, and concerns. While PCC is associated with better health-related quality of life in patients with cancer, patients with ovarian cancer have reported unmet communication needs. We used design thinking to develop an intervention to promote PCC in ovarian cancer care. Following the steps of design thinking, we empathized with stakeholders by reviewing the literature, then created stakeholder and journey maps to define the design challenge. To ideate solutions, we developed a challenge map. Finally, we developed wireframe prototypes and tested them with stakeholders. Empathizing revealed that misaligned visit priorities precipitated suboptimal communication. Defining the design challenge and ideating solutions highlighted the need to normalize preference assessments, promote communication self-efficacy, and enhance visit efficiency. The Collaborative Agenda-Setting Intervention (CASI) elicits patients' needs and preferences and delivers communication guidance at the point of care. Stakeholders approved of the prototype. Design thinking provided a systematic approach to empathizing with stakeholders, identifying challenges, and innovating solutions. To our knowledge, the CASI is the first intervention to set the visit agenda and support communication from within the electronic health record. Future research will assess its usability and acceptability.

Perspectives of international experts and the Danish citizens on the ‘relevant knowledge’ that citizens need for making informed choices about participation in cancer screening: Qualitative study

This study aimed to investigate the perspectives of international experts and Danish citizens on relevant knowledge about population-based breast, colorectal and cervical cancer screening. This was a qualitative interview study with focus group interviews with experts and Danish citizens eligible for breast, colorectal and/or cervical cancer screening. Data were collected using semi-structured interview guides, audio-recorded and transcribed verbatim. A thematic analysis was conducted. Participants were nine international experts from Germany, Canada, the USA, Sweden, the Netherlands and Australia, and 54 citizens from Denmark. Most citizens had 'adequate' or 'problematic' levels of health literacy. Themes that experts and citizens agreed on were: knowledge about the disease and symptoms, practical information about screening, benefits of screening, the option of non-participation and the importance of having numeric information of possible screening outcomes. Experts agreed on the importance of knowledge about the harms of screening, but only a minority of citizens considered this important. The experts and citizens disagreed on the relevance of knowledge about harms of screening and agreed on other relevant knowledge. What experts and citizens find important may not align when making informed decisions. Therefore, experts and citizens needs to be involved when developing questionnaires.

Co-construction of an instructional module to improve the understanding of cancer screening by people with intellectual disabilities: Strategic choices

People with intellectual disabilities (ID) have difficulty in accessing oral or written health information presented in a conventional manner what compromises prevention. This study aims to develop accessible information on breast, cervical and colorectal cancer screening for people with ID. The instructional material has been developed collaboratively by a team involving representatives from different scientific disciplines (medical and psychoeducational) and people with ID. Five principles guided its elaboration, i.e. coconstruction, multimodality, phasing, socio-cognitivism and accessibility. The material created is a 5-component module including a 20-minute easy-toread and understand oral presentation with a slideshow, a workshop that encourages manipulation and discussion, a booklet to take away, a film to consolidate information and a questionnaire. Providing accessible information is considered a key action in reestablishing equality in access to cancer health care and preventing a cascade of consequences. The co-construction of the module ensures its social and ecological validity. An interventional study is underway to verify its efficacy. The best practices for cancer prevention endorse spending enough time to discuss screening. This accessible module can be used to provide people with ID basic information about screening, increase their adherence, and facilitate the discussion on this issue.

Decisions and prompts to screen for cervical, bowel, and breast cancer

To investigate what makes Australians decide to screen and follow through for breast, cervical, and bowel cancer population screening programs. A convenience sample (N = 962) answered open-text questions about their decision to screen and what prompted them to act in an online survey. Open text responses were coded based on shared meaning using content analysis. Frequencies of each code were calculated. For breast and cervical screening, decisions were commonly based on screening being routine (32.58% Findings can inform the development of interventions targeting non-participants of cancer screening programs. Messages to encourage breast and cervical cancer screening should frame screening as part of regular healthcare routine. Messages to encourage bowel cancer screening should encourage immediate use of the screening kit upon arrival.

The impact of communicating uncertain test results in cancer genetic counseling: A systematic mixed studies review

Cancer genetic counseling increasingly involves discussing uncertain test results, for example because multiple genes are sequenced simultaneously. This review was performed to provide insight into how counselors' communication of uncertain test results during genetic counseling for cancer affects counselors and counselees. A systematic mixed studies review was undertaken to review research on the effects of communicating uncertain test results. Four databases were searched using a PICO search strategy. Study findings of articles meeting the inclusion criteria were synthesized narratively. Twenty-four articles were included. Uncertain test results encompassed either an inconclusive test result or a variant of unknown significance (VUS). Counselees involved almost exclusively women at risk of hereditary breast and/or ovarian cancer. None of the articles reported effects on counselor outcomes. Counselee outcomes were categorized as cognitive, affective or behavioral. Interpretation of a VUS was overall reported as difficult, and counselees' distress and worry were repeatedly found to decrease over time after the discussion of any uncertain test result. For most other outcomes, findings were sparse and/or inconsistent. Evidence on effects on counselee outcomes is scant and inconsistent. Future studies are warranted to provide insight into how counselees and counselors are affected. Clinical practice could benefit from guidelines on how to address uncertain test results during pre- and posttest genetic consultations.

Testing key messages about extending cervical screening intervals

We tested the impact of different messages about the rationale for extended cervical screening intervals on acceptability of an extension. Women in England aged 25-49 years (n = 2931) were randomised to a control group or one of 5 groups given different messages about extending cervical screening intervals from 3 to 5 years. Outcome measures were general acceptability and six components from the Theoretical Framework of Acceptability (TFA). The groups who saw additional messages (47-63%) were more likely to find the change acceptable than controls (43%). Messages about interval safety, test accuracy and speed of cell changes resulted in more positive affective-attitudes, higher ethicality beliefs, a better understanding of the reasons for extended intervals and greater belief in the safety of 5-year intervals. Being up-to-date with screening and previous abnormal results were associated with finding 5-yearly screening unacceptable. Emphasising the slow development of cell changes following an HPV negative result and the safety of longer intervals, alongside the accuracy of HPV primary screening is important. Campaigns explaining the rationale for extended cervical screening intervals are likely to improve acceptability. Though women who feel at increased risk, may remain worried even when the rationale is explained.

The relationships of health literacy, preferred involvement, and patient activation with perceived involvement in care among Mongolian patients with breast and cervical cancer

To explore the relationships of health literacy, preferred involvement, and patient activation with perceived involvement in care among patients with breast and cervical cancer. A cross-sectional survey was conducted with patients aged 20 years or older, aware of their cancer diagnosis, and currently receiving care at the National Cancer Center, Mongolia. Descriptive statistics and multivariate regression analysis were used to identify the relationships among study variables. Two hundred twenty-five patients were included in the final analysis. Patients' perceived involvement was examined as two subdomains: patient information seeking (PIS) and patient decision-making (PDM). Patient health literacy was found to only significantly influence PIS, and patient preferred involvement demonstrated a significant influence only on PDM. However, patient activation predictor was found to significantly influence both PIS and PDM (PIS [β = 0.22, p = 0.00] and PDM [β = 0.14, p = 0.00]). Health literacy, preferred involvement, and patient activation each demonstrated distinct influences on patients' perceived involvement subdomains, with patient activation being the most important predictor. Comprehensive strategies at the healthcare organization, professional, and patient levels may help to facilitate and advance patient involvement in care, and ultimately improve the quality of healthcare services respective to domain of patient-centeredness.

National institutions should improve the information made available to patients about cervical smears

To assess the quality of the content of leaflets tools and websites of national institutions in United Kingdom and France informing patients about cervical smears. We collected and analyzed the data and information on these two websites and leaflets made for patients. We screened those tools with the UP TO DATE SCIENTIFIC EVIDENCE IPDAS grid. None of the tools specify the level of evidence of the studies on which cervix cancer screening is based. The risk of complication due to cancer is poor. The effectiveness of screening in absolute value is not available. The risks and side-effects due to cervical smears are specified without the frequency. Information is truncated and pushes readers towards taking part in screening. This is not in accordance with the quality criteria of shared decision making. Patients should take part in the creation of decision making tools, so that the information is the most suited to their representations and understanding. This is why the documents made available by institutions should be based on recognized scientific sources. Responsible of health programs should be independent and separated from those responsible of information tool creation.