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Peterson B, Mikocka-Walus A, Evans S. 'It just stops me from living': A qualitative study of losses experienced by women with self-reported endometriosis. J Adv Nurs 2023; 79:3888-3898. [PMID: 37341349 DOI: 10.1111/jan.15745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/12/2023] [Accepted: 06/10/2023] [Indexed: 06/22/2023]
Abstract
AIMS To understand the experience of loss in Australian women with endometriosis. DESIGN A total of 532 participants completed an online survey containing three open-ended questions relating to pelvic pain and activity loss due to endometriosis. Participants were Australian women aged between 18 and 50 years (M = 30.8, SD = 7.1) with a self-reported diagnosis of endometriosis. An inductive, qualitative approach, with template analysis was used to identify and organize themes. A pragmatic feminist perspective was used to interpret the findings. RESULTS Three main themes were identified: the loss of liberty: 'I'm trapped in the house'; the loss of bodily autonomy: 'I can barely move/breathe/talk' and loss of connection: 'It stops me from being social'. Pain emerged as the greatest concern for participants, preventing them from the physical functioning required to participate in many of life's activities. CONCLUSIONS The losses women with endometriosis experience are wide-reaching, restricting control and choice across multiple life domains. Losses were often unacknowledged by loved ones and healthcare providers, further impacting the physical, emotional and mental health of participants. PATIENT OR PUBLIC CONTRIBUTION People with endometriosis were involved in the design of the study, including identifying topics of interest.
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Affiliation(s)
- Brianna Peterson
- School of Psychology, Deakin University Geelong, Melbourne, Australia
| | | | - Subhadra Evans
- School of Psychology, Deakin University Geelong, Melbourne, Australia
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Facchin F, Buggio L, Dridi D, Barbara G, Vercellini P. The Subjective Experience of Dyspareunia in Women with Endometriosis: A Systematic Review with Narrative Synthesis of Qualitative Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212112. [PMID: 34831868 PMCID: PMC8623407 DOI: 10.3390/ijerph182212112] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/15/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023]
Abstract
Although dyspareunia (pain during intercourse) is common in women with endometriosis, there is poor qualitative evidence describing women’s subjective experience of this symptom. This systematic review of qualitative research aimed to provide an in-depth exploration of women’s lived experience of dyspareunia (i.e., how they perceive and describe their pain, how they deal with it, how it affects their psychological health and intimate relationships). A total of 17 published articles were included. Our findings, derived from thematic analysis, highlighted that endometriosis-related dyspareunia manifests itself in multiple forms (deep, introital, and/or positional dyspareunia, at orgasm, during and/or after intercourse). Women use a variety of coping strategies to deal with sexual pain, such as interrupting or avoiding intercourse, enduring pain to seek pregnancy, and/or finding alternative ways to enjoy sexuality. Dyspareunia impairs women’s psychological health, especially in terms of poor self-esteem and sense of femininity and has negative consequences on intimate relationships. Unfortunately, both women and physicians are often reluctant to discuss sexual issues. Sexual health should be routinely assessed during counselling with endometriosis patients. Helping women find targeted strategies to enjoy sexuality despite endometriosis may significantly improve their psychological health and quality of life.
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Affiliation(s)
- Federica Facchin
- Department of Psychology, Catholic University of the Sacred Heart, Largo Gemelli 1, 20123 Milan, Italy
- Correspondence:
| | - Laura Buggio
- Gynaecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via della Commenda 12, 20122 Milan, Italy; (L.B.); (D.D.); (G.B.)
| | - Dhouha Dridi
- Gynaecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via della Commenda 12, 20122 Milan, Italy; (L.B.); (D.D.); (G.B.)
| | - Giussy Barbara
- Gynaecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via della Commenda 12, 20122 Milan, Italy; (L.B.); (D.D.); (G.B.)
- SVSeD—Service for Sexual and Domestic Violence and Obstetrics and Gynaecology Emergency Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via della Commenda 12, 20122 Milan, Italy
| | - Paolo Vercellini
- Department of Clinical Sciences and Community Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy;
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Mastrangelo M, Turnbull D. The impact of surgically diagnosed symptomatic endometriosis on women's social lives, work and education: An inductive classical content analysis. Aust N Z J Obstet Gynaecol 2021; 62:274-279. [PMID: 34677826 DOI: 10.1111/ajo.13447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/17/2021] [Indexed: 11/29/2022]
Abstract
AIMS The aim of this study is to extend understandings of the impact of surgically diagnosed endometriosis on women's social lives, work and education. METHODS Participants (N = 200; average age: 27.1 years (±6.72)) were recruited from a range of sources, including social media and private women's health clinics. They completed an online survey comprising seven open-ended questions about how experience with endometriosis impacted (i) overall life; (ii) family relationships; (iii) friendships; (iv) attendance at social events; (v) engagement in leisure activities; (vi) work; and (vii) education. Data were analysed using inductive classical content analysis. RESULTS The data set contained 1400 discrete codable statements, with 19% of women reporting some form of social impact. A key result was the role of family and friends, both positive and negative, as well as the positive role that the workplace/educational institution can play (noted by 50% of participants). Findings highlight the negative impact on leisure activities, reported by 86% of women. The exhaustion of sick and unpaid leave was reported by 41% of women. CONCLUSION This study highlights the impact of endometriosis on the social and economic lives of Australian women and underscores the importance of the comprehensive response recommended in the National Action Plan for Endometriosis.
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Affiliation(s)
- Melody Mastrangelo
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Deborah Turnbull
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
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Paisi M, March-McDonald J, Burns L, Snelgrove-Clarke E, Withers L, Shawe J. Perceived barriers and facilitators to accessing and utilising sexual and reproductive healthcare for people who experience homelessness: a systematic review. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:211-220. [PMID: 33122258 DOI: 10.1136/bmjsrh-2020-200799] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION People who experience homelessness face disproportionately poor reproductive health and adverse pregnancy outcomes, including but not limited to unintended pregnancy, abortion, low birth weight and preterm birth, as well as a higher risk of sexually transmitted infections (STIs). Precarious living conditions are known to contribute to poor uptake and engagement with sexual and reproductive healthcare (SRH) for this population. AIM To identify and understand the perceived barriers and facilitators for accessing and utilising SRH for people who experience homelessness from their perspective, and the perspective of support staff/volunteers and healthcare professionals. METHODS Electronic databases and online sources were searched. Two reviewers independently carried out the screening, data extraction, critical appraisal, data synthesis and thematic analysis of findings. RESULTS Following deduplication and screening, 23 papers/reports were considered eligible for the review. Barriers for people experiencing homelessness to accessing and utilising SRH were identified within the themes of complexity, feelings and knowledge (ie, individual-level factors), as well as patient/provider interaction and healthcare system (ie, organisational factors). Facilitators were identified within all of the above themes except for complexity. CONCLUSIONS Both population characteristics and attributes of the healthcare system influence access and utilisation of SRH by people experiencing homelessness. Given the complexity of living conditions associated with homelessness, greater efforts to improve access should be placed on healthcare systems and aspects of care delivery. This systematic review highlights current gaps in the literature and provides recommendations for enhancing future research and practice to meet the needs of this vulnerable group more effectively.
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Affiliation(s)
- Martha Paisi
- School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
- Peninsula Dental Social Enterprise, Peninsula Dental School, University of Plymouth, Plymouth, UK
| | | | - Lorna Burns
- Peninsula Dental School, University of Plymouth, Plymouth, UK
| | | | | | - Jill Shawe
- School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
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Sayer-Jones K, Sherman KA. Body image concerns in individuals diagnosed with benign gynaecological conditions: scoping review and meta-synthesis. Health Psychol Behav Med 2021; 9:456-479. [PMID: 34104570 PMCID: PMC8158251 DOI: 10.1080/21642850.2021.1920949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Benign gynaecological conditions (BCGs) and body image-related concerns are commonly experienced by reproductive-aged female-identified individuals. Qualitative evidence from cancer populations identifies a link between diseases of the sexual organs and body image distress encompassing appearance, sensory and functional aspects. Most BCGs and the impacts on body image have been studied separately. However, commonalities exist between these conditions including chronicity, diagnostic delays, and menstrual-related social stigma. This systematic scoping review and meta-synthesis aimed to compare and contrast the experience of body image in the benign conditions of endometriosis, polycystic ovarian cysts, uterine fibroids, and vulvar intraepithelial neoplasia. Method Electronic databases (MEDLINE, PsycINFO, Scopus, CINAHL, Embase, and Allied and Complementary Medicine) were searched in February 2020 and relevant articles were examined to identify papers that qualitatively explored the relationship between body image and BCGs. Meta-synthesis was used to analyse the 17 papers that met the inclusion criteria. Results Six main themes evolved from this iterative analysis: loss of control; regained control; silence – menstrual concealment; cultural differences; feeling abnormal, and functional impairment. Body image concerns were widespread although impacts on individual’s lives were dependent on the unique symptom profile of each disease which interacted with socio-cultural factors, daily functioning, and feminine identity. Body image concerns were a common, but hidden, experience rarely screened in routine clinical settings despite causing significant distress. Conclusions The chronicity and severity of individuals unique symptom profile often determined the intensity and type of body image concerns individuals described. Across conditions, body image concerns were often left untreated, were concealed, and were associated with reduced quality of life.
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Affiliation(s)
- Katherine Sayer-Jones
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Kerry A Sherman
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
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Ghai V, Subramanian V, Jan H, Thakar R, Doumouchtsis SK. A meta-synthesis of qualitative literature on female chronic pelvic pain for the development of a core outcome set: a systematic review. Int Urogynecol J 2021; 32:1187-1194. [PMID: 33822256 PMCID: PMC8139940 DOI: 10.1007/s00192-021-04713-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/31/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Qualitative research has an increasing role in the development of core outcome sets (COS) adding patient perspectives to the considerations of core outcomes. We aimed to identify priorities of women with experience of chronic pelvic pain (CPP). METHODS The search strategy was a systematic review of qualitative studies identified from Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, EMBASE, MEDLINE and PsycInfo databases. Selection criteria were qualitative studies exploring the experience of women with CPP. Two independent researchers extracted data and summarized findings using thematic analysis. A CERQual assessment was performed to assess the confidence of review findings. RESULTS We identified pertinent issues affecting women with CPP including the lack of holistic care, influence of psychosocial factors and the impact of pain on quality of life. Five meta-themes central to delivering a patient-centred approach were highlighted: acceptance of pain, quality of life, management of CPP, communication and support. Management of CPP was the most commonly reported meta-theme across seven studies and half of studies reported quality of life, management, communication and support. Quality appraisal of included studies identified only a single study that met all CASP (Critical Appraisal Skills Programme) criteria. There was high confidence in the evidence for acceptance of pain, quality of life and communication meta-themes. CONCLUSION Meta-themes revealed by this review should be considered as a priority and reflected in outcomes reported by future studies evaluating interventions for CPP. In addition, these themes should be considered by clinicians managing women with CPP.
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Affiliation(s)
- Vishalli Ghai
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, Dorking Road, London, KT18 7EG UK
- St George’s University of London, Crammer Terrace, London, SW17 0RE UK
| | - Venkatesh Subramanian
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, Dorking Road, London, KT18 7EG UK
| | - Haider Jan
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, Dorking Road, London, KT18 7EG UK
| | - Ranee Thakar
- Department of Urogynaecology, Croydon University Hospital NHS Trust, London, CR7 7YE UK
| | - Stergios K. Doumouchtsis
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, Dorking Road, London, KT18 7EG UK
- St George’s University of London, Crammer Terrace, London, SW17 0RE UK
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, Athens, Greece
- School of Medicine, American University of the Caribbean, Cupecoy, Sint Maarten
| | - CHORUS: An International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women’s Health
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, Dorking Road, London, KT18 7EG UK
- St George’s University of London, Crammer Terrace, London, SW17 0RE UK
- Department of Urogynaecology, Croydon University Hospital NHS Trust, London, CR7 7YE UK
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, Athens, Greece
- School of Medicine, American University of the Caribbean, Cupecoy, Sint Maarten
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Rea T, Giampaolino P, Simeone S, Pucciarelli G, Alvaro R, Guillari A. Living with endometriosis: a phenomenological study. Int J Qual Stud Health Well-being 2020; 15:1822621. [PMID: 32964806 PMCID: PMC7782044 DOI: 10.1080/17482631.2020.1822621] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose: To explore and understand the lived experiences of women with endometriosis. Method: Qualitative study using Cohen phenomenology. Results: The data analysis identified four main themes and two sub-themes. The main themes are: delay in diagnosis, which includes the sub-theme of the misunderstanding of one's state; worsening of one's life, which includes the sub-theme of a painful life; disastrous intimate life with one's partner; and uncertainty about being able to have one's own children. Conclusions: The themes that emerged represent the starting point for further research and for the implementation of specific educational and support strategies that improve self-care, commitment and quality of life for women with endometriosis.
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Affiliation(s)
- Teresa Rea
- Department of Hygiene and Public Health, A.O.U. Federico II, Naples, Italy
| | | | - Silvio Simeone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Assunta Guillari
- Department of Hygiene and Public Health, A.O.U. Federico II, Naples, Italy
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Pokrzywinski RM, Soliman AM, Snabes MC, Chen J, Taylor HS, Coyne KS. Responsiveness and thresholds for clinically meaningful changes in worst pain numerical rating scale for dysmenorrhea and nonmenstrual pelvic pain in women with moderate to severe endometriosis. Fertil Steril 2020; 115:423-430. [PMID: 33066973 DOI: 10.1016/j.fertnstert.2020.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/25/2020] [Accepted: 07/08/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To evaluate the utility, responsiveness, and thresholds for clinically meaningful change of a numerical rating scale for worst pain associated with dysmenorrhea (NRS-DYS) and nonmenstrual pelvic pain (NRS-NMPP) in women with moderate to severe endometriosis-associated pain. DESIGN Analysis of data from two phase III randomized clinical trials (EM-I [NCT01620528] and EM-II [NCT01931670]). SETTING Not applicable. PATIENT(S) Premenopausal women ages 18-49 years with moderate to severe endometriosis-associated pain. INTERVENTION(S) Participants in both trials were randomized 3:2:2 to receive placebo, elagolix 150 mg once daily, or elagolix 200 mg twice daily for 6 months. MAIN OUTCOME MEASURE(S) NRS-DYS and NRS-NMPP. RESULT(S) EM-I enrolled 871 women and EM-II enrolled 815 women. For patients with a global impression of improvement at month 3, the least-squares mean change between baseline and month 3 was -3.6 (EM-I and EM-II) for NRS-DYS and -1.9 (EM-I) and -2.0 (EM-II) for NRS-NMPP. Standard errors of measurement were 2.99 (EM-I) and 2.86 (EM-II) for NRS-DYS and 1.74 (EM-I) and 1.71 (EM-II) for NRS-NMPP. Baseline half standard deviations were 0.78 (EM-I) and 0.85 (EM-II) for NRS-DYS and 0.92 (EM-I) and 0.96 (EM-II) for NRS-NMPP. Based on these results, clinically meaningful changes were defined as a reduction of 4 points for NRS-DYS and 2 points for NRS-NMPP. CONCLUSION(S) This study demonstrated the utility and responsiveness of separate numerical rating scales to assess worst pain for dysmenorrhea and NMPP in women with moderate to severe endometriosis-associated pain and identified initial thresholds for clinically meaningful change.
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Affiliation(s)
| | | | | | | | - Hugh S Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
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Gater A, Taylor F, Seitz C, Gerlinger C, Wichmann K, Haberland C. Development and content validation of two new patient-reported outcome measures for endometriosis: the Endometriosis Symptom Diary (ESD) and Endometriosis Impact Scale (EIS). J Patient Rep Outcomes 2020; 4:13. [PMID: 32072316 PMCID: PMC7028881 DOI: 10.1186/s41687-020-0177-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 02/03/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Endometriosis is a common, chronic, impactful condition in women of reproductive age. In the absence of established sensitive and specific biomarkers, disease severity is determined by patient-reported symptoms and impacts. This article details the development of two new patient-reported outcome (PRO) measures designed to assess efficacy endpoints in clinical studies: The Endometriosis Symptom Diary (ESD) and the Endometriosis Impact Scale (EIS). METHODS The ESD and EIS were developed according to best practice and scientific standards (including the Food and Drug Administration (FDA) PRO Guidance) and with extensive input from women with surgically-confirmed endometriosis. Research included: a review of published qualitative literature; concept elicitation interviews in the US, Germany and France (n = 45) to explore the experiences of women with endometriosis and to inform ESD and EIS development; and cognitive interviews in the US and Germany (n = 31) to assess relevance and understanding of the ESD and EIS and usability of administration using an electronic handheld device. The FDA and the European Medicines Agency (EMA) as well as PRO and clinical experts were consulted throughout the process. RESULTS Pelvic pain was identified as the most frequent, severe and bothersome symptom for women with endometriosis. Pain was reported to be greatest during menstruation (dysmenorrhea) and during or after sexual intercourse (dyspareunia). Pain resulted in significant impairments in physical activities, work/study, social/leisure activities, household activities and sexual functioning. All women highlighted the emotional impact of endometriosis. Descriptions of pain and associated impacts were largely consistent across participants from the US and Europe, with the most notable differences being the words used to describe the location of pain (e.g., 'pelvis' vs. 'abdomen'). Testing during cognitive interviews indicated that the ESD and EIS were well understood and consistently interpreted. Furthermore, all participants found the ePRO devices easy to use and no issues regarding visual presentation, selection of responses or navigation were identified. CONCLUSIONS Evidence from extensive qualitative research supports the content validity of the ESD and EIS as patient-reported measures of the disease-defining symptoms of endometriosis and the associated impact on women's lives. Future research will seek to establish the measurement properties of the measures.
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Affiliation(s)
| | | | | | - Christoph Gerlinger
- Bayer AG, Berlin, Germany
- Obstetrics, Gynecology and Reproductive Medicine, University of Saarland, Homburg, Saar Germany
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Markham R, Luscombe GM, Manconi F, Fraser IS. A detailed profile of pain in severe endometriosis. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2019. [DOI: 10.1177/2284026519838948] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective: To investigate the detailed nature of pain symptoms reported by women with endometriosis and those without current gynecological complaint. Design: Self-administered cross-sectional study was conducted using a structured questionnaire. Setting: Teaching hospital clinic, specialist gynecologist, and family practice patients; endometriosis community support group members; and university staff and students. Subjects: A total of 737 women returned completed surveys: women with endometriosis ( n = 529) and with no current gynecological complaint ( n = 208). Intervention(s): None. Main outcome measure(s): Demographics, experience of pain symptoms: frequency, severity, and characteristics. Results: All pain symptoms were significantly more common among women with endometriosis compared with controls. Women with endometriosis all reported experiencing dysmenorrhea to some degree ( N = 527, two missing), although the severity was “slight” for 5%. Dyspareunia was reported by 92% of women with endometriosis, most commonly during intercourse, rather than at the start or post-coital. The other pain symptoms experienced by women with endometriosis, in order of frequency, were lower back pain (93%), pain at ovulation (87%), pelvic pain other than during menses, ovulation, urination or intercourse (79%), dysuria (71%), and rectal pain (67%). The great majority of women with endometriosis reported multiple sources and types of pain. Among women with endometriosis there were clear associations between the severity of dysmenorrhea and the frequency of experiencing dyspareunia and other pain symptoms. Conclusion: Pain symptoms in women with endometriosis were generally much more extensive and complex than recognized by most clinicians.
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Affiliation(s)
- Robert Markham
- Department of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Georgina M Luscombe
- Department of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Frank Manconi
- Department of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Ian S Fraser
- Department of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- School of Women’s and Children’s Health, UNSW Sydney, Sydney, NSW, Australia
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Chauvet P, Guiguet-Auclair C, Comptour A, Denouël A, Gerbaud L, Canis M, Bourdel N. Feelings and expectations in endometriosis: Analysis of open comments from a cohort of endometriosis patients. J Gynecol Obstet Hum Reprod 2018; 47:281-287. [PMID: 29807206 DOI: 10.1016/j.jogoh.2018.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/20/2018] [Accepted: 05/23/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Endometriosis symptoms may have a negative effect on health-related quality of life (HRQoL). Analyses of open comments are known to be a key source of information and support. The authors aimed to analyse open comments associated with a validation scale study, in order to ascertain whether the questionnaires allowed an adequate exploration of patient preoccupations and in so doing define important quality of life themes not assessed in HRQoL scales. MATERIAL AND METHODS Analysis of open comments, following two questionnaires (SF-36 and EHP-30) as part of a national study evaluating the EHP-30, was performed. Questionnaires were distributed online, via a link to the RedCap Internet platform. The association EndoFrance, a support group for endometriosis patients, notified women of the launching of the study. Women were asked to complete the questionnaire and had the opportunity to comment. Comments were gathered, coded systematically, and categorised by theme. RESULTS Of the 1156 women who responded to the questionnaire, 913 (79.0%) declared having a confirmed surgical diagnosis of endometriosis, and 265 comments were analysed. Comments were classified in 20 themes. Correspondence between the themes and items for both questionnaires and the open comments was investigated for all topics, including those non-addressed by the questionnaires. 8 themes are not mentioned in both questionnaires, 9 themes are covered by EHP-30, two by SF-36 and only one by both. CONCLUSION Anonymous data collection and subsequent analysis proves to be an effective and practical way of obtaining patient opinion on their pathology. Analysis of comments may provide additional and useful information to the classical HRQoL Scale.
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Affiliation(s)
- Pauline Chauvet
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, place Lucie Aubrac, 63100 Clermont-Ferrand, France; Faculty of Medicine, ISIT-University of Auvergne, place Henri Dunant, 63000 Clermont-Ferrand, France
| | - Candy Guiguet-Auclair
- Department of Public Health, PEPRADE, Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France
| | - Aurélie Comptour
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, place Lucie Aubrac, 63100 Clermont-Ferrand, France
| | - Amélie Denouël
- EndoFrance, 01120 Montluel, France; Research and Innovation Department, Montpellier University Hospital, 34090 Montpellier, France
| | - Laurent Gerbaud
- Department of Public Health, PEPRADE, Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France
| | - Michel Canis
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, place Lucie Aubrac, 63100 Clermont-Ferrand, France; Faculty of Medicine, ISIT-University of Auvergne, place Henri Dunant, 63000 Clermont-Ferrand, France
| | - Nicolas Bourdel
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, place Lucie Aubrac, 63100 Clermont-Ferrand, France; Faculty of Medicine, ISIT-University of Auvergne, place Henri Dunant, 63000 Clermont-Ferrand, France.
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12
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Marinho MC, Magalhaes TF, Fernandes LFC, Augusto KL, Brilhante AV, Bezerra LR. Quality of Life in Women with Endometriosis: An Integrative Review. J Womens Health (Larchmt) 2018; 27:399-408. [DOI: 10.1089/jwh.2017.6397] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Manuela C.P. Marinho
- Department of Surgery and Maternidade Escola Assis Chateaubriand of Federal University of Ceará (UFC), Fortaleza, Brazil
| | - Thais F. Magalhaes
- Department of Surgery and Maternidade Escola Assis Chateaubriand of Federal University of Ceará (UFC), Fortaleza, Brazil
| | | | - Kathiane L. Augusto
- Department of Surgery and Maternidade Escola Assis Chateaubriand of Federal University of Ceará (UFC), Fortaleza, Brazil
- Medicine Course of University of Fortaleza (UNIFOR), Fortaleza, Brazil
| | - Aline V.M. Brilhante
- Post-Graduate Program in Public Health, University of Fortaleza (UNIFOR), Fortaleza, Brazil
- Medicine Course of University of Fortaleza (UNIFOR), Fortaleza, Brazil
| | - Leonardo R.P.S. Bezerra
- Department of Surgery and Maternidade Escola Assis Chateaubriand of Federal University of Ceará (UFC), Fortaleza, Brazil
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Behavioral, cognitive, and emotional coping strategies of women with endometriosis: a critical narrative review. Arch Womens Ment Health 2018; 21:1-13. [PMID: 28932912 DOI: 10.1007/s00737-017-0779-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
Abstract
Endometriosis is a disabling and long-term medical condition affecting quality of life and mental health. Behavioral, cognitive, and emotional coping strategies, emotional intelligence, and metacognition could in part explain the link between the disease and impaired psychological and life functioning. This critical narrative review aimed at examining the state of the art of the relationships between endometriosis and these factors. According to PRISMA principles, we performed a systematic search for quantitative and qualitative studies on multiple electronic databases as regards coping strategies, emotional intelligence, and metacognition in women with endometriosis. Studies were subjected to interpretative and critical narrative synthesis. A total of 9 papers were included in the review. Three main categories were identified in thematic analysis and resumed in the manuscript. Findings suggested that (a) pain is considered the major stressor; (b) they usually use both adaptive and maladaptive coping strategies; (c) women with endometriosis and related chronic pain seem to repress emotions more likely than healthy ones; (d) suppressing own emotions, pain catastrophizing, and having a passive coping style are related to higher self-reported pain; and (e) emotional and avoidance coping styles are associated to poor mental status, while positive coping strategies focusing on the problem or on emotions, detached and rational styles are associated to better mental health. Few studies with mixed results and some methodological flaws have focused on coping strategies in women with endometriosis. No studies focusing on metacognition or emotional intelligence were found. Methodological biases, suggestions for future research, and implications for clinical practice were discussed.
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Crowe M, Whitehead L, Seaton P, Jordan J, Mccall C, Maskill V, Trip H. Qualitative meta-synthesis: the experience of chronic pain across conditions. J Adv Nurs 2016; 73:1004-1016. [PMID: 27679971 DOI: 10.1111/jan.13174] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 12/18/2022]
Abstract
AIM To synthesize qualitative descriptions of the experience of chronic pain across conditions. BACKGROUND Chronic pain is a transdiagnostic symptom in that while somatic pathology plays a role in activating pain pathways, psychological and social factors contribute to the experience of pain over time. The treatment of the underlying condition may require both biomedical intervention and biopsychosocial approaches. DESIGN Qualitative meta-synthesis using Confidence in the Evidence from Reviews of Qualitative Research (CERQual) developed by Grading of Recommendations Assessment Development and Evaluation (GRADE) working group to evaluate the strength of the evidence. DATA SOURCES PubMed and Ovid Medline from 2000-2015. REVIEW METHODS Following a systematic search strategy all papers were assessed in relation to inclusion criteria and quality. Themes were extracted from each study and a meta-synthesis conducted before completing an evaluation of confidence in the findings. RESULTS Forty-one papers exploring the experience of chronic pain were included in the review. Five meta-themes were identified across the studies: 1) the body as obstacle; 2) invisible but real; 3) disrupted sense of self; 4) unpredictability; and 5) keeping going. There was high confidence in the evidence for three themes: 'the body as obstacle'; 'disrupted sense of self' and 'keeping going'; and moderate confidence in the evidence for 'invisible but real' and 'unpredictability'. CONCLUSIONS The findings in this review suggest there are similarities in the experience of chronic pain across a range of conditions that have implications for the development of transdiagnostic pain management strategies and interventions.
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Affiliation(s)
- Marie Crowe
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
| | - Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Philippa Seaton
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Catherine Mccall
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
| | - Virginia Maskill
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
| | - Henrietta Trip
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
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Moradi M, Parker M, Sneddon A, Lopez V, Ellwood D. Impact of endometriosis on women's lives: a qualitative study. BMC Womens Health 2014; 14:123. [PMID: 25280500 PMCID: PMC4287196 DOI: 10.1186/1472-6874-14-123] [Citation(s) in RCA: 243] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 09/29/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This study aimed to explore women's experiences of the impact of endometriosis and whether there are differences across three age groups. METHODS A qualitative descriptive design was conducted using semi-structured focus group discussions with 35 Australian women with endometriosis, in three age groups. All tape-recorded discussions were transcribed verbatim and read line by line to extract meaningful codes and categories using NVivo 9 software through a thematic analysis approach. Categories were then clustered into meaningful themes. RESULTS Participants' ages ranged from 17 to 53 years and had a history of 2 to 40 years living with endometriosis, with an average delay time to diagnosis of 8.1 years. Two main themes emerged: (1) experiences of living with endometriosis, and (2) impact of endometriosis on women's lives, with 14 discrete categories. The results showed similarities and differences of the impact between the three age groups. The most highlighted impacts were on marital/sexual relationships, social life, and on physical and psychological aspects in all three age groups, but with different orders of priority. Education was the second most highlighted for the 16-24 years, life opportunities and employment for the 25-34 years; and financial impact for those 35 years and above. CONCLUSIONS Our findings show that endometriosis impacts negatively on different aspects of women's lives. A better understanding of these findings could help to decrease the negative impact of endometriosis by guiding service delivery and future research to meet more effectively the needs of women and teenagers with this condition.
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Affiliation(s)
- Maryam Moradi
- />PhD candidate at the Australian National University School of Medicine, Canberra, Australia
| | - Melissa Parker
- />Endometriosis Clinic, Canberra Hospital, Canberra, Australia
| | - Anne Sneddon
- />School of Medicine, and Gold Coast University Hospital, Griffith University, Kragujevac, Queensland Australia
| | - Violeta Lopez
- />Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - David Ellwood
- />School of Medicine, and Gold Coast University Hospital, Griffith University, Kragujevac, Queensland Australia
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Young K, Fisher J, Kirkman M. Women's experiences of endometriosis: a systematic review and synthesis of qualitative research. ACTA ACUST UNITED AC 2014; 41:225-34. [PMID: 25183531 DOI: 10.1136/jfprhc-2013-100853] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 07/03/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Endometriosis is experienced by approximately 10% of women worldwide; it is associated with significant burden on the woman, her family, and society. AIM The aim of this systematic review was to synthesise the available qualitative literature to increase our understanding of the effects of endometriosis on women's lives. METHODS Seven social science and medical databases (PubMed, Medline, CINAHL, Web of Science, ScienceDirect, PsycInfo and Embase) and Google Scholar were searched for peer-reviewed papers published in English of research using qualitative methods. RESULTS AND CONCLUSIONS Eighteen papers reporting 11 studies met the inclusion criteria. Participant numbers ranged from 15 to 61 women, all recruited from support groups and specialised clinics. Studies were conducted in high-income, Anglophone countries. The review identified four prominent themes: Life, Symptoms, Medical Experience, and Self. Women's reported experiences demonstrated opportunities for enhancing current clinical practice, including improved education about endometriosis for health professionals, the need to take a comprehensive approach to pain treatment, and initiating appropriate discussion of the impact on sex life. Significant evidence gaps were identified: there was inadequate investigation of women's experiences of endometriosis-associated infertility and of the impact of reduced social participation on perceived support and emotional well-being, and limited or no inclusion of the experiences of adolescent and post-menopausal women, women from low socioeconomic backgrounds, women who do not identify as Caucasian, and non-heterosexual women.
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Affiliation(s)
- Kate Young
- PhD Candidate, The Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jane Fisher
- Director, The Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Maggie Kirkman
- Senior Research Fellow, The Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Riazi H, Tehranian N, Ziaei S, Mohammadi E, Hajizadeh E, Montazeri A. Patients' and physicians' descriptions of occurrence and diagnosis of endometriosis: a qualitative study from Iran. BMC WOMENS HEALTH 2014; 14:103. [PMID: 25174639 PMCID: PMC4158003 DOI: 10.1186/1472-6874-14-103] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 08/18/2014] [Indexed: 11/20/2022]
Abstract
Background The prevalence of endometriosis is considerable but its diagnosis is a dilemma. The aim of this study was to explore the perception and experiences of endometriosis patients and physicians about occurrence and diagnosis of endometriosis. Methods A qualitative research using content analysis was used to obtain data from purposely selected endometriosis patients (12 participants) and gynecologists (6 participants) from January to September 2013 in Tehran. Data were coded and analyzed using a thematic approach. Results Seven themes emerged: 1) pain localization, 2) Severity of pain and struggle for pain relief, 3) Feeling inability to play the role of femininity, 4) Reducing physical health, 5) Disruption of social life, 6) Looking for a reliable diagnostic indicator, 7) Uncertainty of physical examination. The results highlighted that patients with the disease can experience different feelings that interfere with their wellbeing and their lives, and sometimes could be disabling. Conclusion Patients and physicians are looking for a certain, noninvasive and inexpensive diagnostic method. This study helps to promote clinical diagnostic view and knowledge development about description of endometriosis diagnosis to decrease diagnostic delay and mismanagement.
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Affiliation(s)
| | - Najmeh Tehranian
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
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Toye F, Seers K, Barker K. A meta-ethnography of patients' experiences of chronic pelvic pain: struggling to construct chronic pelvic pain as 'real'. J Adv Nurs 2014; 70:2713-27. [PMID: 25081990 DOI: 10.1111/jan.12485] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2014] [Indexed: 11/27/2022]
Abstract
AIM To review systematically and integrate the findings of qualitative research to increase our understanding of patients' experiences of chronic pelvic pain. BACKGROUND Chronic pelvic pain is a prevalent pain condition with a high disease burden for men and women. Its multifactorial nature makes it challenging for clinicians and patients. DESIGN Synthesis of qualitative research using meta-ethnography. DATA SOURCES Five electronic bibliographic databases from inception until March 2014 supplemented by citation tracking. Of 488 papers retrieved, 32 met the review aim. REVIEW METHODS Central to meta-ethnography is identifying 'concepts' and developing a conceptual model through constant comparison. Concepts are the primary data of meta-ethnography. Two team members read each paper to identify and collaboratively describe the concepts. We next compared concepts across studies and organized them into categories with shared meaning. Finally, we developed a conceptual model, or line of argument, to explain the conceptual categories. RESULTS Our findings incorporate the following categories into a conceptual model: relentless and overwhelming pain; threat to self; unpredictability, struggle to construct pain as normal or pathological; a culture of secrecy; validation by diagnosis; ambiguous experience of health care; elevation of experiential knowledge and embodiment of knowledge through a community. CONCLUSION The innovation of our model is to demonstrate, for the first time, the central struggle to construct 'pathological' vs. 'normal' chronic pelvic pain, a struggle that is exacerbated by a culture of secrecy. More research is needed to explore men's experience and to compare this with women's experience.
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Affiliation(s)
- Francine Toye
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, UK
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Kiykac Altinbas S, Bayoglu Tekin Y, Dilbaz B, Dilbaz S. Evaluation of quality of life in fertile Turkish women with severe endometriosis. J OBSTET GYNAECOL 2014; 35:49-52. [DOI: 10.3109/01443615.2014.930110] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Economic burden of surgically confirmed endometriosis in Canada. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2012; 33:830-837. [PMID: 21846438 DOI: 10.1016/s1701-2163(16)34986-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To estimate the societal economic burden of illness caused by surgically confirmed endometriosis in Canada in 2009, including direct health care costs, lost productivity, and lost leisure time costs. METHODS Using a cross-sectional design, direct health care resource use data were obtained from nine family physicians and nine gynaecologists from across Canada, who were experienced in the treatment of women with surgically confirmed endometriosis. Data on alternative treatments and health care providers, as well as work absenteeism, lost leisure time, and caregiver time were obtained from a convenience sample of 27 women with endometriosis treated at two gynaecology clinics in Alberta and Quebec. Unit costs were assigned to resource use items for treatment-seeking patients, and total costs for each resource use item were aggregated to estimate the societal costs of endometriosis in Canada in 2009, across all prevalent cases of surgically confirmed endometriosis. RESULTS The estimated mean annual societal cost of endometriosis was $5,200 per patient (95% CI $3,700 to $7,100), with lost productivity and lost leisure time costs accounting for 78%. Extrapolating these figures yields an estimated total annual cost to Canadian society of $1.8 billion (95% CI $1.3 billion to $2.4 billion) attributable to surgically confirmed endometriosis in Canada. CONCLUSION For some women, surgically confirmed endometriosis has a substantial negative impact that can result in suffering to the individual and her family, and lead to substantial productivity losses. Understanding the interplay between direct costs, lost productivity, and quality of life is critical for accurately identifying and evaluating effective treatments for this condition.
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Kaatz J, Solari-Twadell PA, Cameron J, Schultz R. Coping with endometriosis. J Obstet Gynecol Neonatal Nurs 2010; 39:220-5; quiz 225-6. [PMID: 20409124 DOI: 10.1111/j.1552-6909.2010.01110.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Endometriosis not only has physical implications for women but also may affect their sexuality, self-image, and hopes for childbearing. This article discusses the role of parish nurses in a community faith-based setting collaborating to provide comprehensive care for women who are diagnosed with endometriosis. Physical, emotional, and spiritual dimensions of care are highlighted. Traditional and complimentary treatments are described. Examples of outcomes for women in the described program are included in case study exemplars.
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Affiliation(s)
- Joyce Kaatz
- Sanford Women's Health, Sioux Falls, SD, USA
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22
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Fourquet J, Gao X, Zavala D, Orengo JC, Abac S, Ruiz A, Laboy J, Flores I. Patients' report on how endometriosis affects health, work, and daily life. Fertil Steril 2010; 93:2424-8. [PMID: 19926084 DOI: 10.1016/j.fertnstert.2009.09.017] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 08/27/2009] [Accepted: 09/12/2009] [Indexed: 10/20/2022]
Abstract
The objective of this study was to assess the burden of endometriosis by obtaining patient-reported outcome data describing the experience of living with this disease. Survey data from 107 women with self-reported, surgically diagnosed endometriosis showed that living with this disease may be characterized by physical limitations that disrupt health, work, and daily life.
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Affiliation(s)
- Jessica Fourquet
- Department of Microbiology, Ponce School of Medicine, Ponce, Puerto Rico 00731
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Merlin T, Weston A, Tooher R. Extending an evidence hierarchy to include topics other than treatment: revising the Australian 'levels of evidence'. BMC Med Res Methodol 2009; 9:34. [PMID: 19519887 PMCID: PMC2700132 DOI: 10.1186/1471-2288-9-34] [Citation(s) in RCA: 280] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Accepted: 06/11/2009] [Indexed: 11/13/2022] Open
Abstract
Background In 1999 a four-level hierarchy of evidence was promoted by the National Health and Medical Research Council in Australia. The primary purpose of this hierarchy was to assist with clinical practice guideline development, although it was co-opted for use in systematic literature reviews and health technology assessments. In this hierarchy interventional study designs were ranked according to the likelihood that bias had been eliminated and thus it was not ideal to assess studies that addressed other types of clinical questions. This paper reports on the revision and extension of this evidence hierarchy to enable broader use within existing evidence assessment systems. Methods A working party identified and assessed empirical evidence, and used a commissioned review of existing evidence assessment schema, to support decision-making regarding revision of the hierarchy. The aim was to retain the existing evidence levels I-IV but increase their relevance for assessing the quality of individual diagnostic accuracy, prognostic, aetiologic and screening studies. Comprehensive public consultation was undertaken and the revised hierarchy was piloted by individual health technology assessment agencies and clinical practice guideline developers. After two and a half years, the hierarchy was again revised and commenced a further 18 month pilot period. Results A suitable framework was identified upon which to model the revision. Consistency was maintained in the hierarchy of "levels of evidence" across all types of clinical questions; empirical evidence was used to support the relationship between study design and ranking in the hierarchy wherever possible; and systematic reviews of lower level studies were themselves ascribed a ranking. The impact of ethics on the hierarchy of study designs was acknowledged in the framework, along with a consideration of how harms should be assessed. Conclusion The revised evidence hierarchy is now widely used and provides a common standard against which to initially judge the likelihood of bias in individual studies evaluating interventional, diagnostic accuracy, prognostic, aetiologic or screening topics. Detailed quality appraisal of these individual studies, as well as grading of the body of evidence to answer each clinical, research or policy question, can then be undertaken as required.
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Affiliation(s)
- Tracy Merlin
- Adelaide Health Technology Assessment (AHTA), Discipline of Public Health, University of Adelaide, South Australia, Australia.
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Mohammadzadeh A, Heidari M, Soltanghoraee H, Jeddi-Tehrani M, Ghaffari Novin M, Akhondi MMA, Zeraati H, Mohammadzadeh F. Retracted: Evaluation of the effect of pentoxifylline on white blood cell count in serum and peritoneal fluid in female rats with endometriosis. J Obstet Gynaecol Res 2008; 34:307-13. [DOI: 10.1111/j.1447-0756.2008.00745.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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