Patient experiences of being advised by a healthcare professional to get pregnant to manage or treat endometriosis: a cross-sectional study

Assessing healthcare needs in endometriosis: a scoping review

OBJECTIVE

Women with endometriosis still have to seek the legitimacy of their disease from the medical community and often feel unheard. This scoping review aims to map the scientific literature to describe barriers and facilitators in the endometriosis management from both patients' and healthcare professionals' (HCPs') perspectives.

METHODS AND MEASURES

We searched the literature published between 2012 and 2023 in the Web of Science, PsychInfo, PubMed, CINAHL, Embase, and Cochrane Library databases. A total of 52 eligible studies were identified.

RESULTS

We observed several barriers in the endometriosis management: the perception of patients as challenging and psychosomatic; lack of awareness and medical knowledge; persistent taboos and biases; challenging communication about pain, pregnancy, and infertility; lack of empathy from HCPs; and barriers in diagnostic tools and healthcare accessibility. Key facilitators were HCPs and community awareness; taking patients' symptoms seriously; compassionate communication about fertility and pain; shared decision-making, encouraging patients to seek evidence-based information; and multidisciplinary support.

CONCLUSION

We were able to identify concrete barriers and facilitators to successful endometriosis management. Future research is now required to identify optimal ways to implement this evidence, and research the extent to which it applies to more diverse populations in non-Western setting, and to explore the impact of HCP demographic characteristics.

Good-Quality mHealth Apps for Endometriosis Care: Systematic Search

BACKGROUND

Mobile health (mHealth) apps are increasingly being used by community members to track symptoms and manage endometriosis. In addition, clinicians use mHealth apps for continued medical education and clinical decision-making and recommend good-quality apps to patients. However, poor-quality apps can spread misinformation or provide recommendations that are not evidence-based. Therefore, a critical evaluation is needed to assess and recommend good-quality endometriosis mHealth apps.

OBJECTIVE

This study aimed to evaluate the quality and provide recommendations for good quality endometriosis mHealth apps for the community and clinicians.

METHODS

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines informed the search of mHealth apps on the Google Play Store and Apple App Store. The search terms included "endometriosis," "adenomyosis," and "pelvic pain." mHealth apps were eligible if they were (1) related to the search terms, (2) were in the English language, and (3) were available free of cost. Only the free content of the eligible mHealth apps was assessed. ENLIGHT, a validated evaluation tool for mobile and web-based interventions, was used to assess the quality across 7 domains such as usability, visual design, user engagement, content, therapeutic persuasiveness, therapeutic alliance, and general subjective evaluation. mHealth apps with a total score of ≥3.5 were classified as "good" according to the ENLIGHT scoring system and are recommended as good-quality mHealth apps for endometriosis care.

RESULTS

In total, 42 mHealth apps were screened, and 19 were included in the quality assessment. A total of 6 good-quality mHealth apps were identified (QENDO, Bearable, Luna for Health, Matilda Health, Branch Health: Pain Management, and CHARLI Health). These apps provided symptom-tracking functions and self-management support. A total of 17 apps were designed for community use, while 2 apps provided a digital endometriosis classification tool to clinicians. Most mHealth apps scored well (≥3.5) in the domains of usability (16/19, 84.2%), visual design (14/19, 73.7%), user engagement (11/19, 57.9%), and content (15/19, 78.9%). Few eHealth websites scored well on therapeutic persuasiveness (6/19, 31.6%), therapeutic alliance (9/19, 47.4%), and general subjective evaluation (6/19, 31.6%).

CONCLUSIONS

Although time and geographical location can influence the search results, we identified 6 "good-quality" endometriosis mHealth apps that can be recommended to the endometriosis community. mHealth apps designed for community use should evaluate their effectiveness on user's endometriosis knowledge, self-recommended management strategies, pain self-efficacy, user satisfaction, and user quality of life. Digital technology should be leveraged to develop mHealth apps for clinicians that contribute to continued medical education and assist clinical decision-making in endometriosis management. Factors that enhance usability, visual design, therapeutic persuasiveness, and therapeutic alliance should be incorporated to ensure successful and long-term uptake of mHealth apps.

TRIAL REGISTRATION

PROSPERO CRD42020185475; https://tinyurl.com/384dkkmj.

Social media activism and women's health: Endometriosis awareness and support

Objective

While endometriosis is estimated to affect 1 in 10 women globally, awareness of the disease as well as research and funding to fight the disease remains lacking as compared with other chronic diseases. This study examines how social media users utilized Instagram to raise awareness of and mobilize activism around endometriosis by analyzing prominent topics, word associations, and feminism themes in endometriosis-tagged posts on Instagram.

Methods

We used a mixed-method approach of combining computational analyses (topic modeling and word association) and human coding (qualitative thematic analysis) of Instagram posts on endometriosis.

Results

Our results show that while Instagram users discussed a variety of issues related to the disease on the social media platform, these issues tend to focus on four topic areas: (i) living with endometriosis, (ii) pregnancy and endometriosis, (iii) awareness and empowerment, and (iv) women's health and wellbeing. In addition, social media users widely incorporated three feminism themes: (i) bringing attention to invisible disability, (ii) solidarity and support among women, and (iii) advocacy and activism around women's health.

Conclusion

People with endometriosis use Instagram to create an online public sphere for raising awareness of the disease, offering networking and support to other endometriosis patients, and creating a movement for enhancing women's health and wellness. In doing so, they are also addressing sexism and misconceptions about endometriosis that have traditionally contributed to normalizing women's experience of pain associated with endometriosis and consequently delaying endometriosis diagnoses.

Supportive Care Needs of Young Adults With Endometriosis: An Open-Ended Online Survey and Exploration of Unmet Needs

OBJECTIVE

The aim of this study is to identify and explore the unmet needs of adolescents and young adults living with endometriosis.

DESIGN

An open-ended online survey was conducted, with questions derived from prior research looking at areas of unmet need in healthcare, career and work, financial, information, psychological, social and cultural domains.

SETTING AND POPULATION

Self-selecting 18-25 year olds with surgically diagnosed endometriosis (self-reported) currently living in Australia were included as participants.

METHODS

Invitation to participate in an open-ended online survey was shared through the social media of Australian endometriosis organisations and the Royal Women's Hospital, Melbourne. Surveys were analysed qualitatively through template analysis.

MAIN OUTCOME MEASURES

Recording of the unmet supportive care needs of this population was carried out.

RESULTS

One hundred and thirty-one respondents fit the eligibility criteria of being aged 18-25 years (median age 23 years). Most were born in Australia (94%), university-educated (54%) and lived in a metropolitan setting (69%). There was a range of unmet needs that were presented across education, work, healthcare and relationships. Group-specific challenges were identified: doctors either over- or underemphasising future fertility; disrupted sexual and romantic life due to painful sex; managing pain in the classroom and workplace where periods are taboo; and being gender-queer in gynaecological medical spaces.

CONCLUSIONS

The increasingly young age at which patients are receiving an endometriosis diagnosis precipitates a shift in patient care. The treatment decisions that are being made must be reflective of the unique needs of the adolescents who carry the burden of the disease. Clinicians are advised to be aware of and discuss needs with their patients.

PATIENT OR PUBLIC CONTRIBUTION

The nine open-ended questions in this survey were developed from data from a preliminary series of interviews with endometriosis patients in a tertiary women's healthcare centre. In asking these data-informed questions to the online endometriosis community, patients across broader sociocultural demographics and disease states (including less symptomatic endometriosis) have provided a broader understanding of their supportive care needs.

Noninvasive diagnostic imaging for endometriosis part 2: a systematic review of recent developments in magnetic resonance imaging, nuclear medicine and computed tomography

Endometriosis affects 1 in 9 women, taking 6.4 years to diagnose using conventional laparoscopy. Non-invasive imaging enables timelier diagnosis, reducing diagnostic delay, risk and expense of surgery. This review updates literature exploring the diagnostic value of specialist endometriosis magnetic resonance imaging (eMRI), nuclear medicine (NM) and computed tomography (CT). Searching after the 2016 IDEA consensus, 6192 publications were identified, with 27 studies focused on imaging for endometriosis. eMRI was the subject of 14 papers, NM and CT, 11, and artificial intelligence (AI) utilizing eMRI, 2. eMRI papers describe diagnostic accuracy for endometriosis, methodologies, and innovations. Advantages of eMRI include its: ability to diagnose endometriosis in those unable to tolerate transvaginal endometriosis ultrasound (eTVUS); a panoramic pelvic view, easy translation to surgical fields; identification of hyperintense iron in endometriotic lesions; and ability to identify super-pelvic lesions. Sequence standardization means eMRI is less operator-dependent than eTVUS, but higher costs limit its role to a secondary diagnostic modality. eMRI for deep and ovarian endometriosis has sensitivities of 91-93.5% and specificities of 86-87.5% making it reliable for surgical mapping and diagnosis. Superficial lesions too small for detection in larger capture sequences, means a negative eMRI doesn't exclude endometriosis. Combined with thin sequence capture and improved reader expertise, eMRI is poised for rapid adoption into clinical practice. NM labeling is diagnostically limited in absence of suitable unique marker for endometrial-like tissue. CT studies expose the reproductively aged to radiation. AI diagnostic tools, combining independent eMRI and eTVUS endometriosis markers, may result in powerful capability. Broader eMRI use, will optimize standards and protocols. Reporting systems correlating to surgical anatomy will facilitate interdisciplinary preoperative dialogues. eMRI endometriosis diagnosis should reduce repeat surgeries with mental and physical health benefits for patients. There is potential for early eMRI diagnoses to prevent chronic pain syndromes and protect fertility outcomes.