A meta-synthesis of qualitative literature on female chronic pelvic pain for the development of a core outcome set: a systematic review

Abstract

Introduction and hypothesis Qualitative research has an increasing role in the development of core outcome sets (COS) adding patient perspectives to the considerations of core outcomes. We aimed to identify priorities of women with experience of chronic pelvic pain (CPP). Methods The search strategy was a systematic review of qualitative studies identified from Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, EMBASE, MEDLINE and PsycInfo databases. Selection criteria were qualitative studies exploring the experience of women with CPP. Two independent researchers extracted data and summarized findings using thematic analysis. A CERQual assessment was performed to assess the confidence of review findings. Results We identified pertinent issues affecting women with CPP including the lack of holistic care, influence of psychosocial factors and the impact of pain on quality of life. Five meta-themes central to delivering a patient-centred approach were highlighted: acceptance of pain, quality of life, management of CPP, communication and support. Management of CPP was the most commonly reported meta-theme across seven studies and half of studies reported quality of life, management, communication and support. Quality appraisal of included studies identified only a single study that met all CASP (Critical Appraisal Skills Programme) criteria. There was high confidence in the evidence for acceptance of pain, quality of life and communication meta-themes. Conclusion Meta-themes revealed by this review should be considered as a priority and reflected in outcomes reported by future studies evaluating interventions for CPP. In addition, these themes should be considered by clinicians managing women with CPP.

Evaluation of clinical practice guidelines (CPG) on the management of female chronic pelvic pain (CPP) using the AGREE II instrument

“…However, we observed that almost half of all recommendations were made despite the absence of good quality evidence. The shortage of primary research supporting the management of women with CPP may prohibit the development of useful guidelines [18]. Furthermore, the quality of existing RCTs evaluating CPP interventions is variable with significant variability in outcome selection and reporting [5].…”

“…The identification of barriers and facilitators can influence the successful implementation of interventions. In this review, included guidelines may not have incorporated qualitative research findings because of a lack of primary qualitative studies exploring the experiences of women with CPP [18,23].…”

“…The detrimental impact of CPP on quality of life outcomes has been described and identified as a priority for women with CPP [18]. Despite this, quality of life assessment is only reported by half of RCTs evaluating treatments for CPP [5].…”

“…It is vital that clinical pathways are efficient and coordinated. A diagnostic pathway can often be a frustrating and negative experience for women with CPP hindered by delay [18]. Guideline developers such as the National Institute of Clinical Excellence (NICE) have initiatives such as the Patient Public Involvement Programme (PPIP) to support opportunities for patients and the public to be involved in developing guidance.…”

Avoiding the echo‐chamber: embracing qualitative research in obstetrics and gynecology to amplify patient voices

“…Interprofessional conflict, as one example, is both unwieldy and a major threat to patient safety. In their study of interprofessional Taryn Taylor 1,2 Andrea N. Simpson 3,4,5,6 Rohan D'Souza 7,8…”