Strengths and limitations
The strength of this project lies in its women-centred,
multi-disciplinary approach with PPI involvement in the development of a
new OPH-PSS. The tool was designed to be comprehensive, covering all
aspects of the OPH experience and not simply restricting evaluation to
the procedure itself. In this way, valid information was acquired
pertaining to the quality of care before, during and after the
procedure. Moreover, the sample is, to our knowledge, by far the largest
obtained evaluating women’s experience of OPH. The large sample allowed
the generation of precise estimates for various outcomes and with 77
different UK centres providing data enhances the generalisability of
these findings.
Although pilot testing was able to rectify most issues with the OPH-PSS
procedural information was found to be missing in 680 (13.2%) submitted
forms. For the purpose of analysis, it was assumed that all patients,
where the specific hysteroscopic procedure was not defined, had a
diagnostic hysteroscopy procedure performed. This assumption was
conservative but may have led to an overestimate of pain associated with
diagnostic procedures. Furthermore, OPH alone was not a response option
on the survey, rather OPH with or without an endometrial biopsy.
Endometrial biopsy is known to be more painful than OPH14, and so again, the average pain associated with
diagnostic OPH may have been exaggerated. To avoid similar issues in the
future, the final OPH-PSS has been modified to include procedural
details at the beginning of the survey for staff to complete before
seeking patient feedback, and diagnostic OPH without endometrial biopsy
is a specific response category.