Patient-centred care may improve experience during vaginal examination

A study in Singapore finds that patient-centred care, which includes the hospital environment and good communication by the healthcare provider (HCP) and the clinical staff, contributes to a positive experience during pelvic examination (PE) in women.

“More work needs to be done to train clinic staff and HCP on improving communication and procedure skills,” the researchers said. “We also need to have systems in place to ensure patients receive information at every juncture for the procedure, feel more in control during PE, and ensure greater patient involvement in decision-making.”

Twelve participants aged 30‒57 years participated in qualitative semi-structured interviews. The researchers then audio-recorded, transcribed, audited, and analysed the interviews iteratively based on grounded theory.

Themes emerging from the analysis were externally validated and finalized after rounds of deliberations among the researchers. Such themes included descriptions and concepts that reflect the most important matters experienced by the participants.

PE was found to be unpleasant and uncomfortable, particularly when HCPs were deemed to have poor communication and examination skills, according to the participants. [Proc Singap Healthc 2024;doi:10.1177/20101058241270704]

Factors associated with improved patient experience were as follows: a conducive environment (ie, privacy, dim lights) and warm lubricant. Another important consideration was having adequate information before and during the procedure, particularly for first-time patients.

“A calm clinic environment with warm lubricant during PE improved their experience,” the researchers said. “Patient discomfort can be minimized by utilizing the correct speculum size, adequate lubrication, proper positioning, providing privacy for undressing, and draping the thighs.” [J Prim Care Community Health 2021;12:2150132721992195]

The current study also found complementary techniques, such as lavender aromatherapy and music therapy, could be of help. Moreover, warm lighting and privacy in the clinic provided additional comfort to the patients.

“The patient perspective obtained from this study helped us understand patient expectations to make necessary changes to thereby improve compliance to these procedures,” the researchers said.

Guidelines

In Singapore, recommendations and guidelines to improve the awareness of practitioners about the significance and ways of making PEs more comfortable are not yet available.

Earlier studies found that medical students were fearful of hurting the patients, being judged inept by senior doctors, and missing clinical sign during PE. However, other studies found that negative thoughts and fears eventually disappear when students get used to performing PE. [J Med Educ 1979;54:725-728; Cult Health Sex 2016;18:1295-1308]

Medical students can benefit from graduate teaching assistant programs and mannequin simulations, which have been shown to reduce fear and anxiety. [Teach Learn Med 2009;21:116-120]

“We hope that the findings of this study will be used in teaching programs and skills training for medical and allied health practitioners at all levels,” the researchers said. “HCPs require adequate training in skills to help meet patients’ needs and foster a positive experience to encourage regular PE.”