Patients’ perspectives about doctor-patient communication regarding transvaginal mesh implant surgery

Oxlad, Melissa; Edwards, Georgina; McKinlay, Kate A.

doi:10.1016/j.pec.2022.08.021

Cited by 3 publications

(7 citation statements)

References 34 publications

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“…This result is considerably lower than other studies that found 18–24% of patients in urogynecology or urology practices obtained information on transvaginal mesh from health care professionals 11,12 . Faults in patient-physician communication regarding vaginal mesh surgery can stem from giving insufficient information and minimizing procedure risks 30 . A common theme reported among Latina participants in the current study was a desire to learn more from their doctors about mesh in general, associated risks, pros/cons, and alternatives to mesh/surgery.…”

Section: Discussionmentioning

confidence: 68%

“…11,12 Faults in patient-physician communication regarding vaginal mesh surgery can stem from giving insufficient information and minimizing procedure risks. 30 A common theme reported among Latina participants in the current study was a desire to learn more from their doctors about mesh in general, associated risks, pros/cons, and alternatives to mesh/surgery. Physicians should be especially cognizant that certain individuals in this population may prefer alternatives to mesh surgery with appropriate counseling, and should not be "talked into" mesh-based surgery.…”

Section: Discussionmentioning

confidence: 85%

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Aversion to Mesh Use in Pelvic Floor Surgery in a Latina Population at the U.S.-Mexico Border

Florence

Limtrakul

Sanchez

et al. 2023

UROGC

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Importance Limited studies have examined patient aversion to mesh use in pelvic surgery, especially in Latinas. Objective This study aimed to assess aversion to pelvic surgery with mesh for urinary incontinence and pelvic organ prolapse in a sample of Latinas on the U.S.-Mexico border. Study Design This was a cross-sectional study of self-identified Latinas with symptoms of pelvic floor disorders, recruited at their initial consultation visit at a single, academic urogynecology clinic. Participants completed a validated survey to assess perceptions of mesh use in pelvic surgery. Participants also completed questionnaires assessing the presence and severity of pelvic floor symptoms and level of acculturation. The primary outcome was aversion to mesh surgery, as indicated by a response of "yes" or "maybe" to the question "Based on what you already know, would you avoid surgery using mesh?" Descriptive analysis, univariate relative risk, and linear regression analysis were completed to identify characteristics associated with mesh avoidance. Significance was assessed and considered at P values <0.05. Results Ninety-six women were included. Only 6.3% had prior pelvic floor surgery using mesh. Sixty-six percent indicated that they would be likely to avoid pelvic surgery that uses mesh. Only 9.4% indicated that they obtained information regarding mesh directly from medical professionals. Levels of concern regarding the use of mesh varied widely (29.2% not worried, 19.1% somewhat worried, 16.9% very worried). Higher percentages of "more acculturated" participants indicated a desire to avoid mesh surgery (58.7% vs 27.3%, P < 0.05). Conclusions In this Latina population, a majority of patients indicated an aversion to using mesh in pelvic surgery. Few patients obtained information regarding mesh directly from medical professionals, relying instead on nonmedical sources.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 85%

Aversion to Mesh Use in Pelvic Floor Surgery in a Latina Population at the U.S.-Mexico Border

Florence

Limtrakul

Sanchez

et al. 2023

UROGC

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“…Recent research by Oxlad et al and Mckinlay and Oxlad has used Senate Inquiry data to detail failures in doctor-patient communication [ 12 , 13 ]. We will not repeat that analysis here, but build on it.…”

Section: Resultsmentioning

confidence: 99%

“…Most women acknowledged that evidence of potential adverse events was emerging at the time of their operations. However, as reported by Oxlad et al, most women engaged with the Senate Inquiry to report conduct that was inconsistent with accepted practice standards [ 12 ]—and would be so even in the context of providing safe and effective treatment. Oxlad et al’s analysis [ 12 ] supports our second proposed explanation for the persistence of harm: that clinicians’ practices were inconsistent with quality and safety standards, but this was not detected.…”

Section: Resultsmentioning

confidence: 99%

“…However, as reported by Oxlad et al, most women engaged with the Senate Inquiry to report conduct that was inconsistent with accepted practice standards [ 12 ]—and would be so even in the context of providing safe and effective treatment. Oxlad et al’s analysis [ 12 ] supports our second proposed explanation for the persistence of harm: that clinicians’ practices were inconsistent with quality and safety standards, but this was not detected. In addition to promotion of harmful procedures, women reported micro level failures including failure to obtain valid consent (including failure to explain and obtain consent for the implants used), failure to follow up, failure to document and investigate reported symptoms, and blaming, gaslighting or acting in offensive ways to women who raised concerns.…”

Section: Resultsmentioning

confidence: 99%

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Patients’ perspectives on quality and patient safety failures: lessons learned from an inquiry into transvaginal mesh in Australia

Motamedi,

Degeling,

M. Carter

2024

BMC Health Serv Res

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Background Transvaginal mesh (TVM) surgeries emerged as an innovative treatment for stress urine incontinency and/or pelvic organ prolapse in 1996. Years after rapid adoption of these surgeries into practice, they are a key example of worldwide failure of healthcare quality and patient safety. The prevalence of TVM-associated harms eventually prompted action globally, including an Australian Commonwealth Government Senate Inquiry in 2017. Method We analysed 425 submissions made by women (n = 417) and their advocates (n = 8) to the Australian Senate Inquiry, and documents from 5 public hearings, using deductive and inductive coding, categorisation and thematic analysis informed by three ‘linked dilemmas’ from healthcare quality and safety theory. We focused on women’s accounts of: a) how harms arose from TVM procedures, and b) micro, meso and macro factors that contributed to their experience. Our aim was to explain, from a patient perspective, how these harms persisted in Australian healthcare, and to identify mechanisms at micro, meso and macro levels explaining quality and safety system failure. Results Our findings suggest three mechanisms explaining quality and safety failure: 1. Individual clinicians could ignore cases of TVM injury or define them as ‘non-preventable’; 2. Women could not go beyond their treating clinicians to participate in defining and governing quality and safety; and. 3. Health services set thresholds for concern based on proportion of cases harmed, not absolute number or severity of harms. Conclusion We argue that privileging clinical perspectives over patient perspectives in evaluating TVM outcomes allowed micro-level actors to dismiss women’s lived experience, such that women’s accounts of harms had insufficient or no weight at meso and macro levels. Establishing system-wide expectations regarding responsiveness to patients, and communication of patient reported outcomes in evaluation of healthcare delivery, may help prevent similar failures.

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Pain and other complications of pelvic mesh: a systematic review of qualitative studies and thematic synthesis of women’s accounts

Williams,

Lodato,

McGrigor

2024

BMJ Open

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ObjectivesSynthesis of the experience of women with pain from pelvic or vaginal mesh or its removal, to identify pain-related problems and to formulate psychological aspects of pain.DesignSystematic review and thematic analysis of qualitative studies of pain from pelvic or vaginal mesh, or mesh removal, in women over 18 years, using individual interviews, focus groups, free text, or written or oral contributions to formal enquiries.Data sourcesMedline, Embase and PsycINFO, from inception to 26 April 2023.Eligibility criteriaQualitative studies of pain and other symptoms from pelvic or vaginal mesh or its removal; adults; no language restriction.Data extraction and synthesisLine-by-line coding of participant quotations and study author statements by one author to provide codes that were applied to half the studies by another author and differences resolved by discussion. Codes were grouped into subthemes and themes by both authors, then scrutinised and discussed by a focus group of mesh-injured women for omissions, emphasis and coherence. Studies were appraised using an amalgamation of the CASP and COREQ tools.Results2292 search results produced 9 eligible studies, with 7–752 participants, a total of around 2000. Four recruited patients, four totally or partially from mesh advocacy groups, and two were national enquiries (UK and Australia). Four major themes were as follows: broken body, broken mind; distrust of doctors and the medical industry; broken life and keeping going—a changed future. Psychological content mainly concerned the loss of trust in medical care, leaving women unsupported in facing an uncertain future. Mesh-injured women strongly endorsed the findings.ConclusionsPain and other problems associated with pelvic mesh are profound and far-reaching for women affected. Worse, they feel subject to continued gaslighting, including denial of their mesh-related problems and dismissal of their concerns about continued mesh insertion.PROSPERO registration numberCRD42022330527.

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Patients’ perspectives about doctor-patient communication regarding transvaginal mesh implant surgery

Cited by 3 publications

References 34 publications

Aversion to Mesh Use in Pelvic Floor Surgery in a Latina Population at the U.S.-Mexico Border

Aversion to Mesh Use in Pelvic Floor Surgery in a Latina Population at the U.S.-Mexico Border

Patients’ perspectives on quality and patient safety failures: lessons learned from an inquiry into transvaginal mesh in Australia

Pain and other complications of pelvic mesh: a systematic review of qualitative studies and thematic synthesis of women’s accounts

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