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加强子宫肌瘤护理:临床医生对诊断、差异及改善医疗保健策略的看法

Enhancing Uterine Fibroid Care: Clinician Perspectives on Diagnosis, Disparities, and Strategies for Improving Health Care.

作者信息

Laily Alfu, Nair Isha, Shank Sophie E, Wettschurack Cameron, Khamis Grace, Dykstra Chandler, DeMaria Andrea L, Kasting Monica L

机构信息

Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA.

School of Health Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA.

出版信息

Womens Health Rep (New Rochelle). 2024 Mar 27;5(1):293-304. doi: 10.1089/whr.2023.0113. eCollection 2024.

Abstract

OBJECTIVE

To explore clinicians' perspectives on diagnosing, treating, and managing uterine fibroids, identifying gaps and challenges in health care delivery, and offering recommendations for improving care.

MATERIALS AND METHODS

A qualitative design was used to conduct 14 semistructured interviews with clinicians who treat fibroid patients in central Indiana. Interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis techniques. Constant comparative analysis was used to identify emergent themes.

RESULTS

Four themes emerged. (1) Lack of patient fibroid awareness: Patients lacked fibroid awareness, leading to challenges in explaining diagnoses and treatment. Misconceptions and emotional distress highlighted the need for better education. (2) Inequities in care and access: Health care disparities affected Black women and rural patients, with transportation, scheduling delays, and financial constraints hindering access. (3) Continuum of care: Clinicians prioritized patient-centered care and shared decision-making, tailoring treatment based on factors like severity, location, size, cost, fertility goals, and recovery time. (4) Coronavirus disease 2019 (COVID-19) impact: The pandemic posed challenges and opportunities, prompting telehealth adoption and consideration of nonsurgical options.

CONCLUSIONS

Clinician perspectives noted patient challenges with fibroids, prompting calls for enhanced education, interdisciplinary collaboration, and accessible care to address crucial aspects of fibroid management and improve women's well-being.

PRACTICE IMPLICATIONS

Clinicians identified a lack of patient awareness and unequal access to fibroid care, highlighting the need for improved education and addressing disparities. Findings also emphasized the importance of considering multidimensional aspects of fibroid care and adapting to challenges posed by the COVID-19 pandemic, recommending broader education, affordability, interdisciplinary collaboration, and research for better fibroid health care.

摘要

目的

探讨临床医生对子宫肌瘤诊断、治疗及管理的观点,识别医疗服务提供过程中的差距与挑战,并提出改善护理的建议。

材料与方法

采用定性设计,对印第安纳州中部治疗子宫肌瘤患者的临床医生进行14次半结构化访谈。访谈进行了录音,逐字转录,并使用主题分析技术进行分析。采用持续比较分析来识别新出现的主题。

结果

出现了四个主题。(1)患者对子宫肌瘤认识不足:患者对子宫肌瘤认识不足,导致在解释诊断和治疗方面存在挑战。误解和情绪困扰凸显了加强教育的必要性。(2)护理和就医机会不平等:医疗保健差距影响了黑人女性和农村患者,交通、预约延误和经济限制阻碍了他们就医。(3)连续护理:临床医生将以患者为中心的护理和共同决策作为优先事项,根据严重程度、位置、大小、成本、生育目标和恢复时间等因素量身定制治疗方案。(4)2019冠状病毒病(COVID-19)的影响:疫情带来了挑战和机遇,促使采用远程医疗并考虑非手术选择。

结论

临床医生的观点指出了患者在子宫肌瘤方面面临的挑战,促使呼吁加强教育、跨学科合作以及提供可及的护理,以解决子宫肌瘤管理的关键问题并改善女性健康。

实践意义

临床医生发现患者对子宫肌瘤缺乏认识且获得护理的机会不平等,凸显了改善教育和解决差距的必要性。研究结果还强调了考虑子宫肌瘤护理多维度方面以及适应COVID-19疫情带来的挑战的重要性,建议进行更广泛的教育、提高可负担性、跨学科合作以及开展研究以提供更好的子宫肌瘤医疗保健。

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本文引用的文献

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Patient Experiences With a Multidisciplinary Fibroid Program.患者对多学科子宫肌瘤项目的体验。
J Minim Invasive Gynecol. 2024 Jul;31(7):592-600.e2. doi: 10.1016/j.jmig.2024.04.016. Epub 2024 Apr 26.
5
The evolving impact of COVID-19 on women's health.
BJOG. 2023 Feb;130(3):239-240. doi: 10.1111/1471-0528.17373.

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