Understanding patient experiences to improve care for females groin hernia.

Female perspective Groin hernia Person-centered care Qualitative research Sex disparities

Journal

Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653

Informations de publication

Date de publication:
25 Oct 2024
Historique:
received: 09 05 2024
accepted: 31 08 2024
medline: 25 10 2024
pubmed: 25 10 2024
entrez: 25 10 2024
Statut: aheadofprint

Résumé

Thousands of females undergo inguinal hernia repair annually, yet females have been excluded from prior clinical trials evaluating inguinal hernia repairs. Research shows females face worse outcomes after hernia repair compared to males, including higher recurrence rates, increased chronic pain, and limited data to guide treatment. Prospective studies focused on optimizing outcomes for females are critically needed. Prior to conducting such trials, it is essential to obtain preliminary data from female participants to ensure that the studies are designed appropriately to address their priorities and improve sex disparities in outcomes. Semi-structured qualitative interviews were conducted between July 7 and December 31, 2023, with 34 females evaluated for groin hernia. Interviews were conducted via Zoom at an academic medical center. The discussions aimed to explore the challenges in diagnosing hernias, the considerations for selecting treatment options, and the priorities for future research. The transcripts were analyzed using descriptive content analysis, facilitated by MAXQDA software. Diagnostic challenges included delayed recognition due to underappreciation of female hernias. Participants desired greater familiarity with hernias and treatment options from providers. For surgical decisions, fear of complications drove some towards surgery, while others prioritized avoiding recovery time for asymptomatic hernias. Participants called for research on female-specific risk factors, pain experiences, recovery impacts, and non-operative approaches. The majority of participants agreed or considered participating and serving as an advisor in a future study. Females with hernia face sex-based disparities in diagnosis and treatment. Improving provider awareness and developing guidelines are needed. This qualitative study identifies key areas for future research to optimize person-centered hernia care for females based directly on personal perspectives and priorities, laying the groundwork for prospective trials aimed at improving outcomes.

Sections du résumé

BACKGROUND BACKGROUND
Thousands of females undergo inguinal hernia repair annually, yet females have been excluded from prior clinical trials evaluating inguinal hernia repairs. Research shows females face worse outcomes after hernia repair compared to males, including higher recurrence rates, increased chronic pain, and limited data to guide treatment. Prospective studies focused on optimizing outcomes for females are critically needed. Prior to conducting such trials, it is essential to obtain preliminary data from female participants to ensure that the studies are designed appropriately to address their priorities and improve sex disparities in outcomes.
METHODS METHODS
Semi-structured qualitative interviews were conducted between July 7 and December 31, 2023, with 34 females evaluated for groin hernia. Interviews were conducted via Zoom at an academic medical center. The discussions aimed to explore the challenges in diagnosing hernias, the considerations for selecting treatment options, and the priorities for future research. The transcripts were analyzed using descriptive content analysis, facilitated by MAXQDA software.
RESULTS RESULTS
Diagnostic challenges included delayed recognition due to underappreciation of female hernias. Participants desired greater familiarity with hernias and treatment options from providers. For surgical decisions, fear of complications drove some towards surgery, while others prioritized avoiding recovery time for asymptomatic hernias. Participants called for research on female-specific risk factors, pain experiences, recovery impacts, and non-operative approaches. The majority of participants agreed or considered participating and serving as an advisor in a future study.
CONCLUSION CONCLUSIONS
Females with hernia face sex-based disparities in diagnosis and treatment. Improving provider awareness and developing guidelines are needed. This qualitative study identifies key areas for future research to optimize person-centered hernia care for females based directly on personal perspectives and priorities, laying the groundwork for prospective trials aimed at improving outcomes.

Identifiants

DOI: 10.1007/s00464-024-11255-2 PMID: 39453455
pubmed: 39453455
doi: 10.1007/s00464-024-11255-2
pii: 10.1007/s00464-024-11255-2
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Subventions

Organisme : NIDDK NIH HHS
ID : 1K08DK135919-01A1
Pays : United States

Informations de copyright

© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Références

HerniaSurge Group (2018) International guidelines for groin hernia management. Hernia 22: 1-165.
Matikainen M, Aro E, Vironen J, Kossi J, Hulmi T, Silvasti S, Ilves I, Hertsi M, Mustonen K, Paajanen H (2018) Factors predicting chronic pain after open inguinal hernia repair: a regression analysis of randomized trial comparing three different meshes with three fixation methods (FinnMesh Study). Hernia 22:813–818
doi: 10.1007/s10029-018-1772-6 pubmed: 29728882
Burcharth J, Pommergaard HC, Bisgaard T, Rosenberg J (2015) Patient-related risk factors for recurrence after inguinal hernia repair: a systematic review and meta-analysis of observational studies. Surg Innov 22(3):303–17. https://doi.org/10.1177/1553350614552731
doi: 10.1177/1553350614552731 pubmed: 25270082
Ehlers AP, Davidson GH, Deeney K, Talan DA, Flum DR, Lavallee DC (2017) Methods for incorporating stakeholder engagement into clinical trial design. eGEMS: J El Health Data Meth 5(1):4. https://doi.org/10.13063/2327-9214.1274
doi: 10.13063/2327-9214.1274
Hsiao B, Fraenkel L (2017) Incorporating the patient’s perspective in outcomes research. Curr Opin Rheumatol 29:144–149
doi: 10.1097/BOR.0000000000000372 pubmed: 28072590 pmcid: 5710815
Porter LD (2022) The importance of patient engagement to improve healthcare research and safety. Global J Qual Saf Healthcare 5:27–30
doi: 10.36401/JQSH-22-X1
Lyratzopoulos G, Abel G, McPhail S, Neal RD, Rubin G (2013) Gender inequalities in the promptness of diagnosis of bladder and renal cancer after symptomatic presentation: evidence from secondary analysis of an english primary care audit survey. BMJ Open 3(6):e002861. https://doi.org/10.1136/bmjopen-2013-002861
doi: 10.1136/bmjopen-2013-002861 pubmed: 23798742 pmcid: 3693425
Templeman L, Eberhardt J, Ling J (2023) Exploring the health care experiences of women diagnosed with vulvodynia. J Sex Med 20(1):97–106
doi: 10.1093/jsxmed/qdac023 pubmed: 36897241
Howard R, Telem D (2019) Gender matters. Ann Surg 270(1):10–11. https://doi.org/10.1097/SLA.0000000000003323
doi: 10.1097/SLA.0000000000003323 pubmed: 31009389
Köckerling F, Lorenz R, Hukauf M, Grau H, Jacob D, Fortelny R, Koch A (2019) Influencing factors on the outcome in female groin hernia repair: a registry-based multivariable analysis of 15,601 patients. Ann Surg 270(1):1–9. https://doi.org/10.1097/SLA.0000000000003271
doi: 10.1097/SLA.0000000000003271 pubmed: 30921052

Auteurs

Deena Sukhon (D)

Department of Surgery, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA. dsukhon@umich.edu.
Center for Healthcare Outcomes & Policy (CHOP), University of Michigan, Ann Arbor, MI, USA. dsukhon@umich.edu.
Oakland University William Beaumont School of Medicine, Rochester, MI, USA. dsukhon@umich.edu.
ORCID: 0009-0005-1766-0202

Sarah E Bradley (SE)

Department of Surgery, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.

Alex Hallway (A)

Department of Surgery, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.

Brian Fry (B)

Department of Surgery, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
Center for Healthcare Outcomes & Policy (CHOP), University of Michigan, Ann Arbor, MI, USA.

Forrest Hosea (F)

Department of Surgery, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
Center for Healthcare Outcomes & Policy (CHOP), University of Michigan, Ann Arbor, MI, USA.

Leah Schoel (L)

Department of Surgery, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
Center for Healthcare Outcomes & Policy (CHOP), University of Michigan, Ann Arbor, MI, USA.

Michael Rubyan (M)

Department of Surgery, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
Center for Healthcare Outcomes & Policy (CHOP), University of Michigan, Ann Arbor, MI, USA.

Jenny Shao (J)

Department of Surgery, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
Center for Healthcare Outcomes & Policy (CHOP), University of Michigan, Ann Arbor, MI, USA.

Sean O'Neill (S)

Department of Surgery, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
Center for Healthcare Outcomes & Policy (CHOP), University of Michigan, Ann Arbor, MI, USA.

Dana Telem (D)

Department of Surgery, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
Center for Healthcare Outcomes & Policy (CHOP), University of Michigan, Ann Arbor, MI, USA.

Anne P Ehlers (AP)

Department of Surgery, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
Center for Healthcare Outcomes & Policy (CHOP), University of Michigan, Ann Arbor, MI, USA.

Classifications MeSH