Outpatient visits for women with postmenopausal bleeding; What do we tell our patients? A Qualitative study

Abstract

Background Postmenopausal vaginal bleeding is a common complaint and requires diagnostic work-up to rule out endometrial cancer. Blind endometrial aspiration sampling is commonly used as a diagnostic procedure in the outpatient setting, but can cause severe discomfort and pain. Previous studies show that women highly value clear explanations and appropriate management of expectations during gynecological outpatient procedures. We believe that patients’ satisfaction is significantly influenced by these expectations, and thus, we consider counseling by gynecologists to play a crucial role in a patient’s comfort experience. The aim of this qualitative study is to explore counseling practices with a special focus on managing expectations regarding outpatient endometrial aspiration. Methods We conducted a qualitative study to explore communication by gynecologists (in training) with patients during an initial visit for postmenopausal bleeding. We interviewed experienced gynecologists (in training) from multiple medical centers. Grounded theory was used for methodological orientation. Results This qualitative study showed that, during the visit, gynecologists do inform patients about the procedure and its anticipated experience, but often reassure patients as a method to alleviate anxiety. Most respondents used alternative terminology to describe the procedure instead of directly mentioning ‘pain’. We also observed that the amount of information women receive prior to their visit (e.g. by the general practitioner or using a leaflet) is limited. Most respondents state that every aspect of the consultation should be detailed in an information leaflet, including information about potentially painful procedures, although some respondents believe this information could provoke anxiety. Conclusion Gynecologists do inform patients during their visit about the procedure. It is debatable whether gynecologist should specify the degree and nature of pain patients may potentially experience during a procedure or if we should use alternative terminology to describe the procedure while acknowledging the discomfort without explicitly detailing the extent and nature of pain. At this moment little information is provided prior to the visit. Most respondents supported the idea of a standard information leaflet, sent prior to the procedure, as it may potentially be a helpful tool to reduce anxiety and therefore dissatisfaction.