(028) Patient and Provider Perspectives on LEEP/LLETZ Treatment
Authors: Giovannetti O , Tomalty D , Greco S , Kment B , Komisaruk B R , Hannan J , Goldstein S W , Goldstein I , Adams M A 
Published: May 2023

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