Beyond the numbers—understanding women’s experiences of accessing care for abnormal uterine bleeding (AUB): a qualitative study

Abstract

ObjectiveTo gain a deeper understanding of women’s experiences of accessing care for abnormal uterine bleeding (AUB) in order to inform future strategies to improve care pathways, including the early detection of endometrial cancer.DesignWe conducted semistructured interviews with 15 women who attended their first gynaecological specialist consultation for AUB at Wellington Regional Hospital between October and December 2019. Inductive thematic analysis was used to explore experiences and barriers to seeking care.ResultsThe median age of the participant cohort was 45 years, with women self-identifying as New Zealand European (9/15), Māori (2/15) and Pasifika (4/15). All women had sought investigation for their AUB in primary care, for some women this was over a timeframe of many years. For all women, AUB had a significant and traumatic impact on their quality of life including their relationships and their work or education. Women described how they felt they often received inadequate care for AUB, and reported negative experiences with their general practitioner. Timely access was further compounded by feelings of embarrassment and that AUB was a taboo subject, and being able to discuss it with family, friends and their general practitioners was difficult.ConclusionWomen in our cohort experienced a multitude of compounding influences that acted as barriers to them having access to appropriate and timely care. Information campaigns that create awareness around ‘abnormal periods’ alongside better health provider practice guidelines for AUB investigation need to be a priority.

Interventions to improve access to care for abnormal uterine bleeding: A systematic scoping review

“…For women who did engage with primary healthcare providers, dismissal of symptoms 4 and health providers' lack of procedural skills for AUB management were problematic. 7 Health system issues like long waiting lists and delays in assessment and diagnosis were also identified.…”

“…3 Our qualitative study then provided further insights into barriers to women's journey of care for AUB at a tertiary medical center in New Zealand. 4 Before planning an intervention Gynecology & Obstetrics). 2 To search for studies on access to health care, we used terms based on the conceptual framework of "Patientcentred Access to Health Care".…”

“…Abnormal bleeding can reduce quality of life. Women often experience AUB symptoms for years before seeking care or receiving treatment 3–6 . In a UK national audit including 14 545 women with heavy menstrual bleeding (HMB) attending secondary care, 74% of women had symptoms for more than 1 year before seeking treatment and 30.4% reported no previous treatment in primary care 5 .…”

“…Lack of trust, rapport, and shared decision making in doctor‐patient relationships can make communication about sensitive gynecologic issues difficult. For women who did engage with primary healthcare providers, dismissal of symptoms 4 and health providers' lack of procedural skills for AUB management were problematic 7 . Health system issues like long waiting lists and delays in assessment and diagnosis were also identified 4 .…”

“…For women who did engage with primary healthcare providers, dismissal of symptoms 4 and health providers' lack of procedural skills for AUB management were problematic 7 . Health system issues like long waiting lists and delays in assessment and diagnosis were also identified 4 . Barriers to access could lead to delayed management and racial disparities in gynecologic examinations, diagnosis, and healthcare outcomes 8 .…”