Empowering patients is key to improving gynaecology experiences

It is vital that patients feel safe and supported when accessing gynaecology services. There are many excellent healthcare professionals driving forward improvements in gynaecology care, but we know that traumatic experiences continue to occur.12 Patient accounts relating to procedures such as intrauterine device insertions or hysteroscopies are evidence of this.

We have heard patients describe unbearably high levels of pain, exacerbated by the absence of any forewarning from medical professionals. Many have felt their pain was dismissed or ignored and that they were sent on their way without due concern, compassion, or follow-up. These negative experiences can have a damaging, long lasting effect on the relationship between patients and the healthcare system and can leave patients feeling fearful of attending other important health appointments.

Being invited for a routine smear test or other invasive gynaecology procedure is unlikely ever to be met with enthusiasm, but a collaborative and empowering approach can make all the difference to patient experience.3 Informed consent is central to this. This includes patients being given the full range of pain relief options from the outset and time to discuss the pros and cons in relation to their own personal circumstances and preferences. Evidence shows that clinicians are poor judges of patient pain,45 so patients need to be involved throughout the decision making process, encouraged to speak up at any point, and responded to appropriately.

I had a very painful and traumatic intrauterine device insertion myself. There was no mention of the risk of high levels of pain, I was simply told to take a couple of paracetamol for the mild cramping that was to be expected. The reality was different and very distressing. Fifteen years on and I have just had the same procedure again. This time I wanted to be involved in decisions around my pain management from the outset.

I clearly communicated my anxieties and my past experience to the healthcare professionals I spoke with at each stage. To manage the pain, I was given the option to have the procedure under general anaesthetic, which of course comes with its own risk and recovery. I requested a call with the surgeon before the day of my appointment to talk through specific concerns. I felt heard and the doctor saw value in spending time listening to and responding to my questions. It provided an opportunity for positive dialogue and a rebuilding of trust.

On the day, I was given further information about the risks associated with general anaesthesia and basic statistics were shared to help me understand my individualised risk. Although I believe this kind of information should be given further ahead of the appointment so it can be properly absorbed, I was pleased that it was communicated in patient friendly language. I felt supported to weigh up the risks and make a decision that was right for me.

Patients want to feel well informed and that their contributions to their care matter. This is especially true when it comes to intimate procedures. Without shared decision making and clear explanation of the possible pain, there is a greater risk of people leaving a gynaecology procedure feeling that their trust or body has been violated.

All patients facing a gynaecology procedure should be offered the full range of pain relief options from the offset, so they can discuss the benefits and risks and decide the best route for them. Crucially, they need to know beforehand that they can stop the procedure at any point if they feel distressed and that they will be supported if they speak up.

Many patients feel fearful, embarrassed, or anxious when they attend a gynaecology appointment. The intimate nature of the procedures can understandably heighten their sense of vulnerability. Patients might need help to communicate their needs, and their ongoing consent should be sought throughout a procedure. Healthcare professionals could discuss this with patients beforehand, so patients know how they can raise concerns or pause the procedure if they need to. Clinicians could also confirm how they will regularly check in on the patient. Agreeing both verbal and non-verbal options for how the patient can speak up is important, as some people might struggle to vocalise during times of shock.

For some, there are additional worries that if they do not continue to endure high levels of pain to allow the procedure to complete, a life changing diagnosis and related treatment could be delayed. For this reason, it is important that ahead of the procedure they are informed of the options for their care pathway, should it need to be stopped.

Empowering patients to be at the heart of the decision making process about their care is central to improving gynaecology experiences. This takes a dedicated approach to communicating in a way that is informative, compassionate, and responsive. Nurturing a collaborative dialogue between clinician and patient is key to building a future in which positive experiences are standard.