What influences women's preferences for differing medical treatments for heavy menstrual bleeding?
Heavy menstrual bleeding (HMB) affects women’s health, wellbeing and social functioning. However little is known about women’s experiences of treatments including the development of treatment preferences. Nested within a large randomised controlled trial investigating effectiveness of medical treatments for heavy menstrual bleeding (The ECLIPSE Trial www.eclipse.bham.ac.uk) this longitudinal qualitative study sought to explore women’s experiences of medical treatments for HMB. This paper reports findings relating to treatment preferences.
Data were generated by a series of two semi-structured interviews with women who had either consented to participate in the ECLIPSE Trial or had declined due to an expressed treatment preference. The study sample was purposefully selected to include a wide range of women experiencing differing medical treatment options including oral medications such as tranexamic acid and levonorgestrel intrauterine system (LNG-IUS). A grounded approach to analysis was used. Twenty-seven of 52 women interested, were ultimately selected including 17 trial participants randomised to a treatment initially and ten who had a treatment preference from the outset so were not included in the trial. Fifty one interviews were conducted over twenty months, with participants interviewed initially within three months of starting treatment and then twelve to eighteen months later.
In both groups treatment preferences were influenced by knowledge gained from peers. Those with a treatment preference from the outset had determined their preference prior to consultations with health professionals about HMB. Although choices were clearly stated women had difficulties explaining the reasons for their choice to the health professional. Women were more positive about their treatment if they felt ownership of the decision-making process and were also more tolerant of side effects and so tended to persist with preferred treatment. However if a treatment was not successful some women either did not, or were reluctant to consult with their health professional to discontinue treatment or seek an alternative, as they felt responsible for the treatment choices they had made. The most requested treatment was LNG-IUS amongst women who had expressed a treatment preference and most of these women had continued it’s use for more than twelve months. All four women who had a preference for standard treatment had discontinued their treatment at the time of the second interview.
Key findings would suggest that treatment preferences are influenced by peers, and may be developed before consultation with a health professional. Women who felt they had control over treatment choices had a different experience of treatment than those who did not. These findings highlight the impact and importance of shared decision-making on women’s experiences of treatment for heavy menstrual bleeding.
- Gail Prileszky, New Zealand Institute of Community Health Care, Christchurch, New Zealand
- Joe Kai, New Zealand Institute of Community Health Care, Christchurch, New Zealand