Lam Christina, Anderson Britta, Lopes Vrishali, Schulkin Jay, Matteson Kristen
1 Department of Obstetrics and Gynecology, Women & Infants Hospital , Providence, Rhode Island.
2 The American College of Obstetricians and Gynecologists , Washington, DC.
J Womens Health (Larchmt). 2017 Jul;26(7):762-767. doi: 10.1089/jwh.2016.6155. Epub 2017 Mar 20.
Women with abnormal uterine bleeding (AUB) report significant reductions in quality of life (QOL), which can be attributed in many cases to the fear of embarrassing episodes of bleeding. We performed this study to determine whether or not during clinical encounters physicians addressed the impact of AUB on patient-reported QOL.
Between October 2008 and May 2009, we conducted a cross-sectional study of members of the American College of Obstetricians and Gynecologists. Surveys were distributed using a mixed method (web- and mail-based) and included questions about physician characteristics and types of questions used when obtaining a clinical history from a patient with AUB. We calculated the proportion of physicians who endorsed asking each type of clinical question with 95% confidence intervals (CIs).
Four hundred seventeen questionnaires were returned (52%). Ninety-nine percent (95% CI 98.4%-99.9%) reported always asking a bleeding heaviness question, 87.2% (95% CI 83.2%-90.5%) reported always asking a QOL question, and 17.5% (95% CI 13.6%-21.9%) reported always asking a mood associated with bleeding question. Seventy-eight percent specifically asked patients about bleeding through their clothes, and 55% asked about changing social plans because of bleeding. Only 18% endorsed that asking about QOL was most essential for the evaluation of women with AUB. No physician characteristics such as years since completing residency, geography, or gender were associated with how commonly providers reported asking questions regarding impact of bleeding on QOL.
Physicians may not be optimizing patient-provider interactions during menstrual history taking with patients with AUB by failing to assess impact of AUB on QOL in a way that is meaningful to patients.
子宫异常出血（AUB）的女性报告其生活质量（QOL）显著下降，在许多情况下，这可归因于对令人尴尬的出血事件的恐惧。我们开展这项研究以确定在临床诊疗过程中医生是否提及了AUB对患者报告的生活质量的影响。
2008年10月至2009年5月期间，我们对美国妇产科医师学会的成员进行了一项横断面研究。采用混合方法（基于网络和邮件）分发调查问卷，其中包括有关医生特征以及从AUB患者获取临床病史时所使用问题类型的问题。我们计算了认可询问每种临床问题类型的医生比例及其95%置信区间（CI）。
共返回417份问卷（回复率52%）。99%（95%CI 98.4%-99.9%）的医生报告总是询问出血严重程度问题，87.2%（95%CI 83.2%-90.5%）的医生报告总是询问生活质量问题，17.5%（95%CI 13.6%-21.9%）的医生报告总是询问与出血相关的情绪问题。78%的医生特别询问患者是否有血液渗透衣物的情况，55%的医生询问患者是否因出血而改变社交计划。只有18%的医生认可询问生活质量问题对评估AUB女性最为重要。没有医生特征（如完成住院医师培训后的年限、地理位置或性别）与医生报告询问出血对生活质量影响问题的频率相关。
在与AUB患者进行月经病史询问时，医生可能未以对患者有意义的方式评估AUB对生活质量的影响，从而未优化医患互动。
