Page 134 - Strategies for non-invasive managementof high-grade cervical intraepithelial neoplasia - prognostic biomarkers and immunotherapy Margot Maria Koeneman

Chapter 7
Materials and methods
The study design and questionnaire were developed according to Checklist for Reporting Results of Internet E-Surveys (CHERRIES) guidelines.[14] A completed CHERRIES guideline has been attached as a supplement (Supplemental Digital Content 1). Since this study is a survey among physicians, ethical approval was not necessary.
Population
The electronic survey was sent to all gynecologists in the Netherlands who regularly perform colposcopies and treat VAIN and CIN lesions. Since a specific mailing list was not available, all hospitals in the Netherlands in which colposcopies are conducted (n = 87) were contacted by telephone to identify these gynecologists. Of the 87 hospitals, 8 were university hospitals, 37 were large semi-specialized teaching hospitals, and 42 were general non-teaching hospitals. In total, 176 gynecologists were identified and contacted by an e-mail containing an invitation message and a link to the survey. The first invitation was sent in November 2014. Reminders were sent after 3 and 6 weeks to only those gynecologists who had not responded (as tracked by the survey program). The survey was closed after 9 weeks.
Questionnaire
An anonymous electronic questionnaire was designed by the authors and was conducted by using a commercial web survey provider (www.surveymonkey.com). The questionnaire has been attached as a supplement (Supplemental Digital Content 2). The questionnaire was composed by an expert panel of four gynecological oncologists with experience in colposcopy and treatment of VAIN and CIN. The questionnaire was tested by five colleagues; this led to several changes to the questionnaire. The questionnaire consisted of 37 items relating to current colposcopy practice, awareness of imiquimod as an immunotherapy for genital warts and VIN lesions, and as an experimental treatment modality of VAIN and CIN lesions, whether the gynecologist had used imiquimod to treat VAIN and CIN and what the outcomes were (only when relevant), and opinions about imiquimod use for high-grade CIN lesions. The questions concerning current colposcopy practice were included to determine whether the physicians were aware of the risk of premature birth after LLETZ and their clinical practice with regard to this potential adverse effect. The majority of questions were multiple-choice, and it was possible to make a comment. The survey system automatically stored all responses in a database. E-mail addresses of all respondents were stored by the survey system for the purpose of sending reminder messages to non-responders. Respondents could only complete the questionnaire once.
Statistics
The descriptive statistics were generated by using SPSS (IBM Corp., released 2012, IBM SPSS Statistics for Windows, Version 21.0, Armonk, NY).
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