BackgroundPelvic organ prolapse is a common urogenital condition affecting 41–50% of women over the age of 40. To achieve early diagnosis and appropriate treatment, it is important that care is sensitive to and meets women’s needs, throughout their patient journey. This study explored women’s experiences of seeking diagnosis and treatment for prolapse and their needs and priorities for improving person-centred care.MethodsTwenty-two women receiving prolapse care through urogynaecology services across three purposefully selected NHS UK sites took part in three focus groups and four telephone interviews. A topic guide facilitated discussions about women’s experiences of prolapse, diagnosis, treatment, follow-up, interactions with healthcare professionals, overall service delivery, and ideals for future services to meet their needs. Data were analysed thematically.ResultsThree themes emerged relating to women’s experiences of a) Evaluating what is normal b) Hobson’s choice of treatment decisions, and c) The trial and error of treatment and technique. Women often delayed seeking help for their symptoms due to lack of awareness, embarrassment and stigma. When presented to GPs, their symptoms were often dismissed and unaddressed until they became more severe. Women reported receiving little or no choice in treatment decisions. Choices were often influenced by health professionals’ preferences which were subtly reflected through the framing of the offer. Women’s embodied knowledge of their condition and treatment was largely unheeded, resulting in decisions that were inconsistent with women’s preferences and needs. Physiotherapy based interventions were reported as helping women regain control over their symptoms and life. A need for greater awareness of prolapse and physiotherapy interventions among women, GPs and consultants was identified alongside greater focus on prevention, early diagnosis and regular follow-up. Greater choice and involvement in treatment decision making was desired.ConclusionsAs prolapse treatment options expand to include more conservative choices, greater awareness and education is needed among women and professionals about these as a first line treatment and preventive measure, alongside a multi-professional team approach to treatment decision making. Women presenting with prolapse symptoms need to be listened to by the health care team, offered better information about treatment choices, and supported to make a decision that is right for them.Electronic supplementary materialThe online version of this article (10.1186/s12905-019-0741-2) contains supplementary material, which is available to authorized users.
BackgroundPelvic Organ Prolapse (POP) is estimated to affect 41%–50% of women aged over 40. Findings from the multi-centre randomised controlled “Pelvic Organ Prolapse PhysiotherapY” (POPPY) trial showed that individualised pelvic floor muscle training (PFMT) was effective in reducing symptoms of prolapse, improved quality of life and showed clear potential to be cost-effective. However, provision of PFMT for prolapse continues to vary across the UK, with limited numbers of women’s health physiotherapists specialising in its delivery. Implementation of this robust evidence from the POPPY trial will require attention to different models of delivery (e.g. staff skill mix) to fit with differing care environments.MethodsA Realist Evaluation (RE) of implementation and outcomes of PFMT delivery in contrasting NHS settings will be conducted using multiple case study sites. Involving substantial local stakeholder engagement will permit a detailed exploration of how local sites make decisions on how to deliver PFMT and how these lead to service change. The RE will track how implementation is working; identify what influences outcomes; and, guided by the RE-AIM framework, will collect robust outcomes data. This will require mixed methods data collection and analysis.Qualitative data will be collected at four time-points across each site to understand local contexts and decisions regarding options for intervention delivery and to monitor implementation, uptake, adherence and outcomes. Patient outcome data will be collected at baseline, six months and one year follow-up for 120 women. Primary outcome will be the Pelvic Organ Prolapse Symptom Score (POP-SS). An economic evaluation will assess the costs and benefits associated with different delivery models taking account of further health care resource use by the women. Cost data will be combined with the primary outcome in a cost effectiveness analysis, and the EQ-5D-5L data in a cost utility analysis for each of the different models of delivery.DiscussionStudy of the implementation of varying models of service delivery of PFMT across contrasting sites combined with outcomes data and a cost effectiveness analysis will provide insight into the implementation and value of different models of PFMT service delivery and the cost benefits to the NHS in the longer term.
The size limit (2000 characters) excl title including all spaces, punctuation etc 1,983 characs just now Title: A before-and-after feasibility study of an intervention to increase chest physiotherapy adherence among young children with cystic fibrosis Objective: To test the feasibility of delivering and evaluating a theoretically-informed, 2-component intervention (online documentary film and family action plan including behaviour change techniques) to improve adherence to physiotherapy among children with CF aged 0 to 8 years. Methods: Design: mixed-methods, before-and-after feasibility study with repeated measures. Participants: 20 children with CF and their parents recruited via NHS CF clinics and community routes. Feasibility outcomes: intervention acceptability; rates of recruitment, retention and completion of measures (adherence, parental depression/anxiety, and burden of care); change in outcome scores. Assessed at baseline and after 4 and 8 weeks. Qualitative interviews explored parents' experiences/acceptability of the intervention. Inclusion criteria: child with CF aged 1 month to ≤8 years old whose parent/carer administers home physiotherapy. Results: Community recruitment failed. 71% of 14 invited NHS clinics took part (N=10). 75% of 292 screened patients/parents were eligible (N=219). NHS recruitment rate (11%), participant recruitment (100%) and retention (85%), measure completion (100%), intervention acceptability (100%) and scores on measures exceeded targets of 10%, >50%,≥70%, ≥80%, ≥75% and 'stay the same/improve' respectively. 23 completed parent/child consent forms were returned-20 were contacted, recruited and took part; attrition was 15% (N=17). 17 parents (100%) used the film which they saw as acceptable (supportive, non-patronising). Only 7 used the action plan due to lack of perceived need related to high baseline adherence (N=14/20 adherent). Overall, 8 weeks after baseline, the trend for adherence increased (mean increase in N physiotherapy sessions = 0.68). Reported parental depression/anxiety (mean change in anxiety score =-2.53; depression score=-0.71) and perceived care burden decreased (mean change in score =-2.33). Conclusions: A larger-scale study is feasible.
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