Addressing Challenges in Endometriosis Pain Communication Between Patients and Doctors: The Role of Language

Slippery Knowledge: Ignorance, Ecologies, and Environment in Endometriosis Framing

Despite a growing body of literature linking environmental toxins and endometriosis, environmental issues make only occasional appearances in public, patient, and specialist conversations about endometriosis. These conversations may hover at the edges of public discourse, but do not gain traction. Based on ethnographic work in the United Kingdom, this article develops the concept of "slippery" knowledge as that which evades action. Ignorance of environmental or ecological etiologies is less a dearth of information than a dearth of possibilities for action. This article elaborates two ways of conceiving of environmental or ecological disease: the exposure model predicated on harmful external factors "getting in" to damage individuals or communities and the embodied ecologies model, which posits inevitable and ongoing mutual imbrication among living and non-living entities. Knowledge regarding endometriosis is "slippery" in both models. Whether knowledge seems actionable or not is inextricable from deep-seated power dynamics related to colonialism, gender, and race, which perpetuate ways of knowing (and acting) on endometriosis that are troubling and troublingly durable.

Experiences of pain communication in endometriosis: A meta-synthesis

INTRODUCTION

Endometriosis is the leading cause of chronic pelvic pain among women. The pain associated with endometriosis significantly impacts various aspects of patients' quality of life. A notable void in the literature is the absence of a systematic review exploring pain communication between patients with endometriosis and healthcare professionals. Hence, the aim of this qualitative systematic review was to synthesize findings on how patients with endometriosis experience communicating with healthcare professionals about pain and how healthcare professionals experience these interactions.

MATERIAL AND METHODS

A systematic literature search was conducted related to patients with endometriosis and pain communication in CINAHL PLUS with full text and MEDLINE (via EBSCO host) on May 12, 2023, and updated January 26, 2024. Searches were supplemented by backward searching reference lists and forward searching citations of included reports in Scopus and Google Scholar. The review was guided by the four-step meta-synthesis methodology by Sandelowski and Barosso. Critical appraisal of included studies was conducted using Critical Appraisal Skill Program (CASP). Findings were analyzed thematically, using the approach described by Thomas and Harden. The meta-synthesis was based on a registered protocol in PROSPERO (CRD 42023425430), and the study is reported adhering to the PRISMA 2020 checklist.

RESULTS

Overall, 37 reports published from 2003 until 2023 contributed to the review, including 4842 participants. Through thematic analysis, we developed the following themes: "Navigating the double burden," "Lack of mutual understanding," and "The complexities of conveying pain."

CONCLUSIONS

The communication of pain between patients with endometriosis and healthcare professionals is complex, encompassing patterns of disbelief, normalization, and psychological attribution. Engaging in discussions about pain presents diverse challenges stemming from insufficient communication skills and assessment tools. Further research is warranted to comprehensively explore the perspectives of both patients and healthcare professionals, aiming to devise strategies that enhance communication and patient care.

Using language to identify a bladder pain component in women with Dysmenorrhoea-Related Pelvic Pain: A cross-sectional study

BACKGROUND

Dysmenorrhoea-Related Pelvic Pain (DRPP) is a common condition, which may or may not include bladder-related symptoms. Primary health care practitioners (PHCP) rely heavily on language for diagnosis of DRPP-related conditions. However, there are no established pain descriptors to assist PHCP to determine whether an individual's DRPP may include a bladder component.

AIMS

To identify differences in the use of pain descriptors in women with DRPP with and without a co-existing bladder pain component, through an exploratory study of the language of pelvic pain in women.

MATERIALS AND METHODS

A cross-sectional online survey of Australian and New Zealand women (n = 750, ages 18-49) who have self-identified pelvic pain. Free text and predetermined pain descriptors used by women with a self-perceived bladder pain component (DRPPB+, n = 468) were compared to those without bladder pain (DRPPB-, n = 282). Statistical analysis included Pearson χ2, logistic regression and analysis of variance tests using StataCorp Stata Statistical Software combined with qualitative data from AntConc concordance software.

RESULTS

Within free-form text, bloating (P = 0.014) and pressure (P = 0.031) were used more commonly to describe dysmenorrhoea in women with DRPPB+, while the word excruciating (P < 0.001) was more commonly used by women with DRPPB-. From a pre-determined list of descriptors, pounding (P < 0.001), tingling (P < 0.001), stabbing (P = 0.010), burning (P = 0.002) and cramping (P = 0.021) were more commonly used by women with DRPPB+, than women with DRPPB-.

CONCLUSIONS

Systematic patterns of word use should encourage practitioners to further enquire about bladder symptoms that may co-exist with dysmenorrhoea. Knowledge of these words may be useful in targeting diagnostic and therapeutic interventions.

Visual reconstructions of endometriosis pain: An interdisciplinary visual methodology for illness representation

OBJECTIVES

Endometriosis is a chronic condition in which tissue resembling the endometrium grows outside of the womb, causing severe chronic pain. Research demonstrates the physical, emotional and quality of life impact on people with endometriosis, but pain is reportedly difficult to communicate, resulting in lengthier diagnosis. This work aimed to gain insight into the value of imagery production as a pain communication strategy through a novel synergy of psychological and linguistic/socio-semiotic approaches.

DESIGN

A qualitative, multimodal, participant-generated imagery study.

METHODS

Interpretative phenomenological analysis (IPA) and conceptual metaphor and metonymy analysis were utilized to examine visual representations of endometriosis pain. Data were collected in two focus groups with four and six women, respectively; all with a diagnosis of endometriosis, aged 25-40 years old (M = 34.5, SD = 4.2) and a mean diagnosis delay of 8.4 years (SD = 3.6).

RESULTS

The overarching theme across visual representations was 'Pain as Physical Violence' with 'colour as emotional representation', 'texture as sensory qualities' and 'materials as sensation' as sub-themes. These are realized through metaphorical and metonymical relations in both the visual representations as well as the accompanying linguistic representation of the process.

CONCLUSIONS

This study demonstrates the value of a creative mixed-methodologies approach to capture experiential aspects of pain and its impact that are not verbalized in linguistic accounts alone. This can facilitate a deeper understanding of one's pain, acting as a medium for therapeutic adjustment to occur, while facilitating effective and empathic patient-professional conversations surrounding pain.

Primary care clinicians' perspectives on interacting with patients with gynaecological conditions: a systematic review

BACKGROUND

Studies have found that women with gynaecological conditions and symptoms do not feel listened to by primary care clinicians (PCCs). Less understood is whether PCCs perceive that there are challenges around listening to and interacting with this patient group.

AIM

To understand PCCs' perspectives on the challenges of listening to and interacting with women patients with gynaecological conditions and symptoms.

DESIGN & SETTING

Systematic review of English-language studies.

METHOD

We searched ASSIA (Applied Social Sciences Index and Abstracts), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Embase, HMIC (Healthcare Management Information Consortium), and MEDLINE from inception to July 2023. We also conducted forward and backward citation searches of included studies. Identified records were screened independently by two reviewers. Data extraction was undertaken by one reviewer and checked by a second. Quality appraisal used the Wallace checklist. 'Best-fit' framework synthesis was used to synthesise findings around themes that explored the challenges of patient-clinician interaction.

RESULTS

We identified 25 relevant articles. Perceived challenges associated with listening to and interacting with patients with gynaecological conditions and symptoms were identified at four 'levels': individual clinician level factors; structural and organisational factors; community and external factors; and factors related to gynaecological conditions. Interpretive analysis identified specific challenges relating to sociocultural factors affecting the consultation experience; the need for further education, training, or guidance for clinicians; factors affecting referral decisions; and factors related to service structure and organisation.

CONCLUSION

PCCs acknowledge that empathy, respect, and attentive listening are important when interacting with women patients with gynaecological conditions and symptoms. However, these ideals are impeded by several factors.

Physical and psychosocial factors are crucial for maintaining physical and mental health in endometriosis: a longitudinal analysis

OBJECTIVE

To test the associations of physical and psychosocial factors with physical and mental health in individuals living with endometriosis (EM) by means of cross-sectional and longitudinal analyses.

METHODS AND MEASURES

Data were gathered via an online survey between February and August 2021. At survey date t1, sociodemographic, EM-related and psychosocial factors as well as physical and mental health of people with EM were assessed. At survey date t2 three months later, physical and mental health was reassessed. The sample consisted of n_t1 = 723 (30.60 ± 6.31 years) and n_t2 = 216 (30.56 ± 6.47 years) cis women with EM. Statistical analyses included bivariate and partial correlation analyses and hierarchical regression analyses.

RESULTS

The participants' physical health was within the average range and their mental health was below-average at t1 and t2. Cross-sectional analyses revealed that worse health was associated with longer diagnostic delay, more surgeries, greater pelvic pain and lower sense of coherence, self-efficacy, sexual satisfaction and satisfaction with the gynecological treatment. In longitudinal analyses, pelvic pain and participants' satisfaction with the gynecological treatment remained significantly associated with health.

CONCLUSION

Treatment should address both pelvic pain and psychosocial factors to improve long-term physical and mental health in EM.

Feasibility and desirability of screening search results from Google Search exhaustively for systematic reviews: A cross-case analysis

A commonly reported challenge of using Google Search to identify studies for a systematic review is the high number of results retrieved. Thus, 'stopping rules' are applied when screening, such as screening only the first 100 results. However, recent evidence shows that Google Search estimates a much higher number of results than the viewable number, raising the possibility of exhaustive screening. This study aimed to provide further evidence on the feasibility of screening search results from Google Search exhaustively, and to assess the desirability of this in terms of identifying studies for a systematic review. We conducted a cross-case analysis of the search results of eight Google Search searches from two systematic reviews. Feasibility of exhaustive screening was ascertained by calculating the viewable number of results. Desirability was ascertained according to: (1) the distribution of studies within the results, irrespective of relevance to a systematic review; (2) the distribution of studies which met the inclusion criteria for the two systematic reviews. The estimated number of results across the eight searches ranged from 342,000 to 72,300,000. The viewable number ranged from 272 to 364. Across the eight searches the distribution of studies was highest in the first 100 results. However, the lowest ranking relevant studies were ranked 227th and 215th for the two systematic reviews. One study per review was identified uniquely from searching Google Search, both within the first 100 results. The findings suggest it is feasible and desirable to screen Google Search results more extensively than commonly reported.

Mediating Pain: Navigating Endometriosis on Social Media

With the rise of social media, many people with endometriosis have turned to platforms such as Facebook and Instagram in the face of lacking care. This qualitative study focuses on why and how people with endometriosis use these platforms. Despite the risks of misinformation and conflict on social media, the results of this research show that many people with endometriosis find these spaces beneficial, particularly for information sharing, social support, representation, and advocacy practices around endometriosis. Using data collected from surveys and interviews, this study reveals that people with endometriosis often use social media to understand, experiment with, and navigate their symptoms and that these efforts deserve recognition by endometriosis researchers and practitioners. This article proposes that, in order to improve future patient-practitioner and patient-researcher relationships for endometriosis, we must understand, not dismiss, the social media practices of those with endometriosis. By understanding how and why patients turn to social media, clinicians and researchers can build toward more patient-oriented futures.