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.