(028) Patient and Provider Perspectives on LEEP/LLETZ Treatment
Bibliographic record
Abstract
Abstract Introduction The loop electrosurgical excision procedure (LEEP) and large loop excision of the transformation zone (LLETZ) are highly effective in the treatment of cervical dysplasia. Though recent studies have identified the potential for negative outcomes following LEEP/LLETZ, the role of the cervix in sexual responses is contentious and has not been considered in conjunction with quality of life and relationship outcomes. Accordingly, there is a limited understanding of the patient and healthcare provider perspectives on procedural outcomes and experiences. Specifically, regarding current counselling and resource practices, and how risk information is represented in provider-patient interactions. Objective To investigate the procedural experiences associated with LEEP/LLETZ from patients who have reported bothersome symptoms and from providers who routinely perform the procedure. Also, to characterize a symptom profile for this subpopulation of patients and explore factors which may influence provider decision-making and approaches to care. Methods Patients who underwent LEEP/LLETZ treatment and reported negative outcomes, and providers with experience performing LEEP/LLETZ were recruited. Patients first completed an online survey which assessed demographic background, medical history, and sexual function. Both patients and providers completed semi-structured interviews relating to LEEP/LLETZ procedural outcomes and experiences. Interview responses were transcribed (Trint), and qualitative analyses were completed using NVivo 12. Results Perspectives and experiences gathered from patient and provider interviews revealed misaligned narratives surrounding LEEP/LLETZ outcomes and treatment. Patients reported a unique symptom profile and negative outcome experiences. Patient narratives highlighted impacts on domains of sexual functioning, including altered physical sensations and orgasm response, changed vaginal discharge and loss of arousal, interest and desire. Patients voiced changes to overall quality of life, with impacts on daily living and effects on interpersonal relationships. Patients discussed preferring open-ended and directed questions to comprehensively elucidate negative outcomes. Provider narratives outlined the current process of care, emphasizing limited experiences with adverse outcomes and the use of open-ended questions during counselling. Providers described an evolving intention to accommodate for and create comfortable clinical spaces. Regarding pre-and post-operative resources, patients described seeking support from online patient groups, and providers disclosed limitations to providing resources. Conclusions Results of this study call attention to discordance in the perceptions of patients and providers regarding LEEP/LLETZ procedural outcomes and experiences. The findings support the need for developments in pre-and post-operative procedural counselling, including a shift towards provider-initiated conversations to elucidate patient concerns. They also reveal a unique symptom profile of this subpopulation of patients who experience negative outcomes post-LEEP/LLETZ, which should be recognized within clinical practice with accessible conversations and resources. Disclosure No
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.000 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".