Interventions to support shared decision-making for women with heavy menstrual bleeding: A systematic review

Abstract

This review studies women's preferences for shared decision-making about heavy menstrual bleeding treatment and evaluates interventions that support shared decision-making and their effectiveness. PubMed, Cochrane, Embase, Medline and ClinicalTrials.gov were searched. Three research questions were predefined: 1) What is the range of perspectives gathered in studies that examine women facing a decision related to heavy menstrual bleeding management?; 2) What types of interventions have been developed to support shared decision-making for women experiencing heavy menstrual bleeding?; and 3) In what way might women benefit from interventions that support shared decision-making? All original studies were included if the study population consisted of women experiencing heavy menstrual bleeding. We used the TIDieR (Template for Intervention: Description and Replication) checklist to assess the quality of description and the reproducibility of interventions. Interventions were categorized using Grande et al. guidelines and collated and summarized outcomes measures into three categories: 1) patient-reported outcomes; 2) observer-reported outcomes; and 3) doctor-reported outcomes. Fifteen studies were included. Overall, patients preferred to decide together with their doctor (74%). Women's previsit preference was the strongest predictor for treatment choice in two studies. Information packages did not have a statistically significant effect on treatment choice or satisfaction. However, adding a structured interview or decision aid to increase patient involvement did show a positive effect on treatment choice and results, patient satisfaction and shared decision-making related outcomes. In conclusion shared decision-making is becoming more important in the care of women with heavy menstrual bleeding. Structured interviews or well-designed (computerized) tools such as decision aids seem to facilitate this process, but there is room for improvement. A shared treatment choice is only possible after careful provision of information, elicitation of patients' preferences and integrating those preferences. Interventions should be designed accordingly.

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

“…Patient‐level interventions in this review focus on the use of patient information and decision tools to improve the ability to engage and shared decision making in consultations. This resonates with a previous systematic review on interventions supporting shared decision making for women with HMB, 39 which found decision aids to be helpful but could be improved with more attention to the collaborative element. Interventions using computer‐ or web‐based decision aids conducted in western and high‐income countries could result in generalizability issues with replicating the study in countries with limited access to technology.…”

The difficult journey to treatment for women suffering from heavy menstrual bleeding: a multi-national survey

“…In a clinical setting, this involves many factors, including prior experience, existing knowledge, trust and confidence in the clinician, personality traits, exposure and access to information, satisfaction with the consultation process, and the influence of family and others [23]. Patients' involvement in their healthcare has increased in recent years [24,25], and the inclusion of patients' preferences in the management of HMB is crucial [26].…”

Woman and girl-centred care for those affected by female genital mutilation: a scoping review of provider tools and guidelines

“…Several systematic reviews have explored how tools such as structured interview guides and infographics developed to increase women’s involvement in reproductive health decision making at the point of care have affected women’s knowledge, treatment choice and results, and women’s satisfaction. These include decision aides for heavy menstrual bleeding [ 34 ], abortion [ 35 ], contraception, vaginal birth after caesarean delivery, and pelvic organ prolapse [ 36 ]. While no studies have examined the use of such tools in shared decision-making in FGM contexts, several studies have examined how such tools have supported parent decision-making concerning male circumcision.…”