(019) Disclosure of LEEP Complications: Qualitative Analysis of Hospital-affiliated Online Resources in Canada
Authors: Giovannetti O , Tomalty D , Greco S , Griffiths H , Adams M 
Published: June 2023

Abstract

Introduction
The Loop Electrosurgical Excision Procedure (LEEP) efficiently removes abnormal or cancerous cells of the cervix. In recent years, studies have reported on the risks of this procedure. Short-term risks are most consistently reported in the literature, including bleeding, discharge, and cervical stenosis.
Long-term risks to pregnancy viability, sexual function, and emotional/psychological wellbeing have also been studied, though to a lesser extent. The dissemination of risk information to patients can take several forms, including physician-patient consultations, discussions with other members of the healthcare team, physical pamphlets and brochures, in addition to online resources. Hospital-affiliated online resources can be used as a measure of how current published literature is translated into practice in the Canadian context.

Objectives
The objective of this study was to determine whether the risks reported in the literature, that impact pregnancy viability, sexual function, and emotional/phycological wellbeing, are communicated to patients via hospital-affiliated online publicly accessible resources. It also aimed to identify the basis for document curation either from recently published literature or provincial/federal governing agencies.

Methods
A thorough review of the Canadian Ministry of Health databases for each province identified all the institutions that perform LEEP (n=25). Institutional websites were used as the data source for compiling all online publicly accessible resources. Qualitative analysis of documents was performed using NVivo 12.

Results
The results from this study indicate that there is discordance between the risks reported in the peer-reviewed literature and the information in online patient-facing resources. More than half of the institutions reported at least one short-term risk, compared to only a quarter that reported at least one long-term risk. Of the documents that had information regarding pregnancy viability, information about pre-term labour was contradictory with some documents reporting increased risk and others reporting no risk. One institution reported on sexual function, specifically that the procedure does not impact sexual function with the justification that it does not impair the ability to have sex. The language used to describe the procedure and its potential risks was variable, with several institutions relying on medical jargon or minimizing words to convey information. Further, of the twenty-five institutions analyzed, only three specified the references they used to develop their document. Forty percent of the documents did not include a date of last update, and of those that did, more than half had not been updated since 2015. This study was unable to find consistent provincial or federal guidelines that informed the curation of these online resources.

Conclusions
This study indicates that there are inconsistencies between the risks and complications reported in the literature and the information available to patients in the form of hospital-affiliated online resources. This study also determined that there are not provincially or federally mandated guidelines from which these online LEEP resources can be curated. Future studies will aim to 1) determine whether there is sufficient evidence about LEEP-associated risks to justify translating this knowledge to patients and 2) recommend a streamlined process for the inclusion of basic science data in the curation of hospital-affiliated online resources.

Disclosure
No.