Counseling is key with HPV diagnosis

Where do you rank when it comes to counseling patients on a positive diagnosis of genital human papillomavirus (HPV) infection?

In a 1996 survey of about 600 women infected with HPV, 52% of those responding ranked the quality of information and counseling from their providers as "poor to fair," with 20% receiving no counseling at all.1

Providers need to understand that a diagnosis of HPV has tremendous psychological impact on a patient, says Linda Alexander, PhD, FAAN, president and chief executive officer of the American Social Health Association (ASHA) in Research Triangle Park. ASHA is spotlighting genital HPV this month during its coordination of the seventh annual National STD Awareness Month.

"Maybe for the provider who dispenses this diagnosis on a regular basis, the significance is somewhat diluted, but for the individual patient who is faced with the reality of having a lifetime, incurable, infectious disease that they feel is going to impact every part of their sexual being, it really can be a very serious diagnosis," she says.

Women who participated in the survey, which was sponsored by ASHA, said that providers need to be willing to discuss sexual matters in an open, nonjudgmental fashion, listen to patients' concerns about the personal impact of the disease, and provide clear information on treatment issues.

Provider, patient resources

The Centers for Disease Control and Prevention (CDC) in Atlanta supports providers and patients through the National STD Hotline (800) 227-8922. The hotline, which ASHA provides under contract to the CDC, offers information on HPV and other sexually transmitted diseases.

"The hotline number is a great number to give out. It's hard to get good information, and the terminology can be confusing," says Katherine Stone, MD, a medical epidemiologist with the CDC's Division of STD Prevention and a member of ASHA's HPV Scientific Advisory Committee.

ASHA also offers a variety of printed material, including brochures, booklets, and a quarterly newsletter, HPV News. The newsletter not only covers psychosocial issues surrounding HPV, but offers breaking medical information on possible diagnostic tools and treatments. ASHA also coordinates a number of HPV support groups across the United States.

"We expect providers to know everything, and that's not fair to providers," Alexander says. "If providers can provide patients with resources where they can go for additional information and help, then the patient doesn't feel quite so alienated and isolated."

Allow patients to process the information surrounding the diagnosis of positive HPV infection, she says. Give them a chance to ask questions that not only deal with the clinical dimensions of the disease, but the psychosocial/sexual aspects as well. Be prepared to review key points several times for the learning process to occur.

"While providers may feel a little frustrated that they are repeating information, the reality is that the patient probably needs to hear it multiple ways and in multiple forms before he or she is able to process the information," Alexander says.

ASHA offers a free brochure, A Practical Guide for the Tongue-Tied: How to Talk With Your Health Care Provider About HPV and Other STDs, during April to help patients discuss HPV. (See insert.)

Reference

1. American Social Health Association. ASHA Survey: Most women with HPV find provider counseling inadequate. ASHA STD News Winter 1996/Spring 1997; 4(2-3).