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![Page 1: Hysterosalpingogram- the patients perspective Maggie Williams Clinical Lead Nurse Radiology Gateshead Health NHSF Trust.](https://reader038.fdocuments.net/reader038/viewer/2022103022/56649d145503460f949e919d/html5/thumbnails/1.jpg)
Hysterosalpingogram- the patients perspective
Maggie Williams
Clinical Lead Nurse Radiology
Gateshead Health NHSF Trust
![Page 2: Hysterosalpingogram- the patients perspective Maggie Williams Clinical Lead Nurse Radiology Gateshead Health NHSF Trust.](https://reader038.fdocuments.net/reader038/viewer/2022103022/56649d145503460f949e919d/html5/thumbnails/2.jpg)
Hysterosalpingogram
• Outpatient procedure
• Varying levels of importance
• Doctor who is free, radiology/gynaecology consultant, specialist nurse.
• Fitted in around other procedures.
![Page 3: Hysterosalpingogram- the patients perspective Maggie Williams Clinical Lead Nurse Radiology Gateshead Health NHSF Trust.](https://reader038.fdocuments.net/reader038/viewer/2022103022/56649d145503460f949e919d/html5/thumbnails/3.jpg)
Patients experience before appointment
• 18 months to 2 years infertility.
• Highly emotional
• Referred via GP
• Gynaecology OPD
• Referral for HSG
![Page 4: Hysterosalpingogram- the patients perspective Maggie Williams Clinical Lead Nurse Radiology Gateshead Health NHSF Trust.](https://reader038.fdocuments.net/reader038/viewer/2022103022/56649d145503460f949e919d/html5/thumbnails/4.jpg)
Following referral for HSG
• Written information leaflet
• Verbal information at Gynae OPD
• Letter asking to telephone for appointment on first day of menstrual cycle.
![Page 5: Hysterosalpingogram- the patients perspective Maggie Williams Clinical Lead Nurse Radiology Gateshead Health NHSF Trust.](https://reader038.fdocuments.net/reader038/viewer/2022103022/56649d145503460f949e919d/html5/thumbnails/5.jpg)
How well does this prepare our patients?
• Still asked:
• Where do you put the injection?
• How do you get the dye into my tubes?
• Do I have to take my pants off?
• Will it hurt?
• My friend says it is awful.
![Page 6: Hysterosalpingogram- the patients perspective Maggie Williams Clinical Lead Nurse Radiology Gateshead Health NHSF Trust.](https://reader038.fdocuments.net/reader038/viewer/2022103022/56649d145503460f949e919d/html5/thumbnails/6.jpg)
This made us think:
• Are we preparing our patients well enough?
• What do our patients want from us?
![Page 7: Hysterosalpingogram- the patients perspective Maggie Williams Clinical Lead Nurse Radiology Gateshead Health NHSF Trust.](https://reader038.fdocuments.net/reader038/viewer/2022103022/56649d145503460f949e919d/html5/thumbnails/7.jpg)
We decided to investigate
2 areas:
• Women’s perception of pain
• Women's expectations and emotions around time of HSG
![Page 8: Hysterosalpingogram- the patients perspective Maggie Williams Clinical Lead Nurse Radiology Gateshead Health NHSF Trust.](https://reader038.fdocuments.net/reader038/viewer/2022103022/56649d145503460f949e919d/html5/thumbnails/8.jpg)
Perception of Pain
Audit of
• Pain during the HSG
• Type and length of pain
![Page 9: Hysterosalpingogram- the patients perspective Maggie Williams Clinical Lead Nurse Radiology Gateshead Health NHSF Trust.](https://reader038.fdocuments.net/reader038/viewer/2022103022/56649d145503460f949e919d/html5/thumbnails/9.jpg)
Patient audit
• 60 patients asked to complete and return questionnaire
• 45 responses
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ResultsType of Pain(%)
0
5
10
15
20
25
30
35
40
45
50
Cramps
Stabbing pain
Cramps &stabbing pain
Dull ache
Other
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Results (cont) Duration of Pain
0
5
10
15
20
25
30
Only duringHSG
A couple ofhours
All day
A number ofdays
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Results (cont)Pain Score(%)
0
2
4
6
8
10
12
14
16
18
Score of 10
Score of 9
Score of 8
Score of 7
Score of 6
Score of 5
Score of 4
Score of 3
Score of 2
Score of 1
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Summary
• The majority of patients experienced crampy pain for the duration of HSG.
• A smaller but significant number of patients had pain for length of time after HSG
• Majority of patients had pain score of 5
or more.
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Changes.
Amended patient information leaflet to advise patients to take simple analgesia prior to procedure.
Re audited patients.
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Second audit.
Same audit with additional questions:
• Did you take any painkillers before the HSG?
• What type of painkillers?
• 35 responses.
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ResultsType of Pain (%)
0
5
10
15
20
25
30
Cramp
Stabbing
Cramp &Stabbing
Dull ache
Other
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Results (cont) Duration of Pain
0
2
4
6
8
10
12
Only duringHSG
A couple ofhours
All day
A number ofdays
![Page 18: Hysterosalpingogram- the patients perspective Maggie Williams Clinical Lead Nurse Radiology Gateshead Health NHSF Trust.](https://reader038.fdocuments.net/reader038/viewer/2022103022/56649d145503460f949e919d/html5/thumbnails/18.jpg)
Results (cont)Pain Score (%)
0
5
10
15
20
25 Score of 10
Score of 9
Score of 8
Score of 7
Score of 6
Score of 5
Score of 4
Score of 3
Score of 2
Score of 1
![Page 19: Hysterosalpingogram- the patients perspective Maggie Williams Clinical Lead Nurse Radiology Gateshead Health NHSF Trust.](https://reader038.fdocuments.net/reader038/viewer/2022103022/56649d145503460f949e919d/html5/thumbnails/19.jpg)
Type of Analgesia taken.
0
2
4
6
8
10
12 Not Stated
Anadin Extra
Ibufren only
Paracetamol &Codeine
Paracetamolonly
Ibufren ¶cetamol
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Summary of results
• 68% of patients took analgesia prior to HSG examination
• 97% of patients still experienced pain during or after HSG.
• 34% during HSG only
• 34% for a couple of hours, but
• 20% for a number of days after.
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Summary of results (cont)
• 82% of original group and 80% of second group scored pain 5 or higher
• Pain scores of those who hadn’t taken analgesia ranged from 2-10.
• Were mainly towards higher end of scale.
• Use of simple analgesia in this group had little effect on pain scores.
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Summary of results (cont)
• Women who took simple analgesia prior to HSG seemed to have little benefit.
• Pain scores 80% 5 or more
• This did not correlate with our perception of patient pain
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Other studies
• Duffy et al 2008:
• Reviewed current practice in 104 UK centres.
• 50% gave formal advice re pain relief
• 35% offered no analgesia
• Did not review the effect of analgesia
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Women's emotions and expectations
We decided to progress our work to look at:
• What are women's emotions and expectations of HSG?
• Do we meet their needs?
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Research Study
• Patients referred for HSG
• Sub fertility
• Referred from within Trust
![Page 26: Hysterosalpingogram- the patients perspective Maggie Williams Clinical Lead Nurse Radiology Gateshead Health NHSF Trust.](https://reader038.fdocuments.net/reader038/viewer/2022103022/56649d145503460f949e919d/html5/thumbnails/26.jpg)
Aims
• To inform our knowledge about the specific needs of this group of women.
• Discover the underlying issues that women have at the start of sub fertility investigations
• Raise awareness of the need of research by nurses in areas where they are practicing.
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Conclusion of literature review
• High incidence of anxiety and depression in sub fertile women
• Low incidence of qualitative studies addressing this situation
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Method
• Qualitative study using grounded theory research
• We used interviews and scheduled them prior to HSG
• During interview we asked 12 Core questions allowing the women to expand their answers to each question
• 10 Recorded Interviews: approx one to one and half hour duration.
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Question Categories
• Background to their sub fertility or
their story• Expectations: pain, dignity, results.• Importance of HSG to them• Formal support from professionals• Informal support from families
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Results
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A number of themes developed
• Written information does not meet all of the patients needs
• Women see HSG as a defining moment
• Sub fertility is still a taboo subject
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Written information does not meet all of women's needs.
• Information giving is not as simple as often thought
• Written information not always read and often produces additional questions
• One woman said “I was horrified” after seeing the information leaflet
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Written information does not meet all of women's needs. (cont)
• Verbal explanation needed to support written information
• When asked “..do you have any questions” at an out patient appointment women do not know if they have any questions because they have not read the information leaflets
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Women see HSG as a defining moment
• Women rated the importance of HSG between 8 and 10. 10 being the most important
• Signpost to further treatment
• Watershed moment
• ‘No progress can be made without it’
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Sub fertility- a taboo subject
• Loss of well being• Loss of self confidence• Anticipatory grief at potential
childlessness.
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Sub fertility- a taboo subject (Cont)
• Women found infertility hard to talk about.• ‘I don’t want to be the source of other
peoples gossip’
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Anxiety permeated all
themes
Conclusions directed towards
anxiety reduction
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Implications for Practice
• Recognition that written information meets only part of the information requirements of women.
• Women need verbal support from professionals along with written material: this allows their specific needs to be addressed leading to an increased ability to cope and reduction in anxiety
![Page 39: Hysterosalpingogram- the patients perspective Maggie Williams Clinical Lead Nurse Radiology Gateshead Health NHSF Trust.](https://reader038.fdocuments.net/reader038/viewer/2022103022/56649d145503460f949e919d/html5/thumbnails/39.jpg)
Implications for Practice
• The role of the Advanced Nurse Practitioner should be reviewed
• Nurse Practitioners can take a lead• Nurse Practitioners can use their role to
advance education and communication between all specialities involved in the sub fertility field
• This would produce a seamless service
![Page 40: Hysterosalpingogram- the patients perspective Maggie Williams Clinical Lead Nurse Radiology Gateshead Health NHSF Trust.](https://reader038.fdocuments.net/reader038/viewer/2022103022/56649d145503460f949e919d/html5/thumbnails/40.jpg)
Implications for Wider Practice
• Health care professionals should recognise that written information may not reduce patient anxiety levels – verbal support should be available to compliment the patient information leaflet.
• Sub fertility should stop being a taboo subject.
• Raising the profile of focus groups.
![Page 41: Hysterosalpingogram- the patients perspective Maggie Williams Clinical Lead Nurse Radiology Gateshead Health NHSF Trust.](https://reader038.fdocuments.net/reader038/viewer/2022103022/56649d145503460f949e919d/html5/thumbnails/41.jpg)
Overall Conclusion
• Women do find HSG painful
• Do we offer effective analgesia?
• Do we meet women's information needs?
• Do we address women's anxieties?
• Do we prepare HSG patients adequately?
![Page 42: Hysterosalpingogram- the patients perspective Maggie Williams Clinical Lead Nurse Radiology Gateshead Health NHSF Trust.](https://reader038.fdocuments.net/reader038/viewer/2022103022/56649d145503460f949e919d/html5/thumbnails/42.jpg)
References
• Duffy,JMN, Gaity A, Watson AJS (2008) Pain Relief during Hysterosalpingography: A national survey.Human Fertility 11(2) 119-121
• Williams M, Green L & Roberts K (2010) Exploring the needs & expectations of women presenting for hysterosalpingogram: A qualitative study.
Currently unpublished.
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Any Questions?