Patient experiences of outpatient hysteroscopy.

OBJECTIVES: Patient perspectives have an important role in improving the quality of outpatient hysteroscopy (OPH) services. Understanding women's experiences can help provide important insights regarding the OPH journey. The purpose of this paper is to share perspectives and reflect on the experiences of women that participated in a national benchmarking OPH survey. In addition, we explore the correlation between women's experience of OPH and reported pain scores. MATERIAL AND METHODS: Over a two-month period, 5151 women took part in the national OPH survey. Free text comments relating to women's OPH experience, collected as part of the survey, were subjected to qualitative analysis using NVivo 12 software to provide a better understanding of the OPH journey. In addition, correlations were drawn between the qualitative and quantitative data collected for pain scores and satisfaction using SPSS software. RESULTS: 1720 (33.3%) women provided comments on their OPH experience. Qualitative thematic analysis generated themes that were divided into positive (82%) and negative (7%) experiences of care. Potential areas of improvement in relation to the OPH service were highlighted in 11% of themes. Most women regarded OPH as a safe, tolerable, and well delivered outpatient service. Quantitative analysis showed that 1829 (35.5%) women reported procedural pain between 70 and 100 mm. These women reported equivalent quality of care on a 10 cm visual analogue scale (9.71 [SD1.04] vs. 9.76 [0.73]; P = 0.06) but were more likely to decline having the procedure done in the same way again (19.4% vs. 3.1%; RR 6.30, 95% CI 5.06 to 7.83) compared to women with pain scores < 70 mm. CONCLUSION: Qualitative data supports the usefulness, safety, tolerability, and acceptance of hysteroscopy in an outpatient setting by most women. However, the reasons for high procedural pain, poor tolerability and negative experiences warrant review and exploration of both individual patient and relevant institutional factors including training, equipment, and local processes.

A Systematic Review of the Effect of Type, Pressure, and Temperature of the Distension Medium on Pain During Office Hysteroscopy.

OBJECTIVE: To identify the optimal distension medium type, pressure, and temperature to minimize pain during office hysteroscopy. DATA SOURCES: MEDLINE, EMBASE, CINAHL, and CENTRAL were searched from inception to January 29, 2020. METHODS OF STUDY SELECTION: We included randomized controlled trials in which women undergoing office hysteroscopy were randomized to either a distension medium type, pressure, or temperature against a suitable control, where pain was an outcome. Data regarding feasibility, visualization, complications, and satisfaction were also collected. TABULATION, INTEGRATION, AND RESULTS: The literature search returned 847 studies, of which 18 were included for systematic review and 17 for meta-analysis. There was no significant difference in intraprocedural pain when comparing the use of normal saline against carbon dioxide (standardized mean difference [SMD], -0.12; 95% confidence interval [CI], -0.36 to 0.13). Subgroup analysis of high-quality studies revealed a statistically significant reduction in postprocedural pain with normal saline (SMD, -0.65; 95% CI, -1.14 to -0.16). Side effects were less frequent (Peto odds ratio, 0.29; 95% CI, 0.20-0.40) and patient satisfaction was higher (SMD, 1.39; 95% CI, 0.51-2.28) with normal saline compared with carbon dioxide. Pressures of ≤40 mm Hg reduced intraprocedural pain (SMD, -0.67; 95% CI, -1.09 to -0.26) at the expense of a higher proportion of unsatisfactory views (81%-89% at ≤40 mm Hg vs 95%-99% at ≥50 mm Hg). Postprocedural pain was reduced with lower filling pressures. Warming saline did not reduce intraprocedural pain (SMD, 0.59; 95% CI, -0.14 to 1.33). CONCLUSION: Normal saline, instilled at the lowest pressure to acquire a satisfactory view, should be used for uterine distension during office hysteroscopy to minimize pain.