Pap smears are invasive and have potential for harm. Currently in women’s health care, verbal and written consent for pap smears is lacking. Information and consent in relation to pap smears is sometimes not offered to women and some women are even led to mistakenly believe that pap smears are mandatory.
Dr. Joel Sherman, in his article (source) on the absence of informed consent, states that women are “pushed into getting Paps, but never told the pros and cons of screening”. The fact that cervical cancer is rare is usually not mentioned to women, nor is the fact that screening is potentially harmful. Dr. Sherman notes that he has seen “a spontaneous outpouring of sentiment from women who are angry that the facts on cervical cancer have been hidden from them”.
Dr. Andrew Rouse, senior lecturer at the University of Birmingham, outlines formal informed consent guidelines (source) that doctors should be following prior to performing pap smears. These guidelines should include the following five steps:
1. Inform women of the absolute benefit of their participation in the
cervical screening programme. The benefit to an individual woman of
attending the National Health Services Cervical Screening program is extremely small.
2. Inform women of the inaccuracy of the test and disadvantages of being
3. Always make sure that women understand what they have been told
4. Inform women that because the Health Authority pays them to perform Pap
smears that there may be a conflict of interest.
5. Familiarize themselves with the General Medical Council’s booklet: Seeking patients
consent: the ethical considerations.
Dr. Margaret McCarthy, a GP who does not have pap smears, states that she thinks it’s “bad practice to cajole and occasionally frighten women into smear tests” (source). Dr. McCarthy notes that doctors are incentivized to perform smears, that women have been cajoled and occasionally frightened into having smears, and that women have “felt humiliated, bullied, harried” when wishing to decline. Dr. McCarthy states “a great many women are being directed into cervical screening without knowing that it’s a choice and without giving fully informed consent”.
Providing a written consent form to women prior to a pap smear may help to improve current practices. A pap smear consent form could also help to establish a respectful shared decision process between women and their doctors. Women would have an opportunity to ask questions, to weigh the pros and cons of screening, and to make an informed choice.
Below is an example of a pap smear consent form. Unfortunately the use of such forms does not appear to be standard practice. In the meantime women still have the option to simply say ‘no’ to a pap smear if they choose to forego the test.
PAP SMEAR CONSENT
I, __________________________________________________________ (please print your full name),
□ AUTHORIZE a pap smear collection. I have been provided with information and I am aware of the potential benefits and the potential harms.
□ DECLINE to have pap smear collection. I understand that if I request to return to the office to have the pap smear done at a separate visit I may be responsible for that visit in its entirety.
PATIENT Signature: ____________________________________ Date/Time: ________________
WITNESS Signature: ____________________________________ Date/Time: ________________
PHYSICIAN Signature: ___________________________________ Date/Time: ________________