Rationale and Objectives
Women with pelvic pain or abnormal uterine bleeding may undergo diagnostic imaging. This study evaluates patient experience in transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) and explores correlations between preference and symptom severity.
Materials and Methods
Institutional review board approval was obtained for this Health Insurance Portability and Accountability Act-compliant prospective study. Fifty premenopausal women with pelvic symptoms evaluated by recent TVUS and MRI and without history of gynecologic cancer or hysterectomy were included. A phone questionnaire used validated survey instruments including Uterine Fibroid Symptoms Quality of Life index, Testing Morbidities Index, and Wait Trade Off for TVUS and MRI examinations.
Results
Using Wait Trade Off, patients preferred TVUS over MRI (3.58 vs 2.80 weeks, 95% confidence interval [CI] −1.63, 0.12; P = .08). Summary test utility of Testing Morbidities Index for MRI was worse than for TVUS (81.64 vs 87.42, 95%CI 0.41, 11.15; P = .03). Patients reported greater embarrassment during TVUS than during MRI ( P < .0001), but greater fear and anxiety both before ( P < .0001) and during ( P < .001) MRI, and greater mental ( P = .02) and physical ( P = .02) problems after MRI versus TVUS. Subscale correlations showed physically inactive women rated TVUS more negatively (R = −0.32, P = .03), whereas women with more severe symptoms of loss of control of health (R = −0.28, P = .04) and sexual dysfunction (R = −0.30, P = .03) rated MRI more negatively.
Conclusion
Women with pelvic symptoms had a slight but significant preference for TVUS over MRI. Identifying specific distressing aspects of each test and patient factors contributing to negative perceptions can direct improvement in both test environment and patient preparation. Improved patient experience may increase imaging value.
Introduction
Patient preference in diagnostic testing, including imaging, is an area of emerging interest as the practice of medicine evolves to incorporate patient-centered care and support patient autonomy . Women with pelvic pain or abnormal uterine bleeding because of fibroids or other conditions frequently undergo diagnostic imaging examinations such as transvaginal ultrasound (TVUS) or magnetic resonance imaging (MRI) to evaluate for treatable causes of their symptoms. These imaging examinations differ in both diagnostic efficacy and patient testing experiences. Although ultrasound (US) is usually the most appropriate initial imaging study for women with pelvic pain or abnormal uterine bleeding , MRI provides additional anatomic and functional information and, in some cases, may be the preferred initial (or only) test if the patient cannot tolerate TVUS. Each examination has distinct diagnostic utility, and the purpose of patient preference assessment is not simply to shift decision-making from physicians to patients, but to identify factors that impact testing experiences and patient-centered value in imaging.
In our own practice, some gynecologist providers have identified patient discomfort and intolerance among the obstacles to expanding MRI utilization. Understanding patient experiences, and therefore drivers of preference in imaging, could provide a valuable roadmap for more patient-centered care. Therefore, we sought to test the hypothesis that patients prefer TVUS over MRI because of better testing experience with TVUS. This study evaluates patient preference and experience with TVUS and MRI and explores correlations between imaging experiences and symptom severity.
Materials and Methods
Participants
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Questionnaire
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Statistical Analysis
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Results
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TABLE 1
Summary Demographic Data for All Patients and From Each Recruitment Arm
All Patients Arm 1: Imaging Studies Performed Only for Research Arm 2: Imaging Studies Performed on Clinical Basis_P_ Value for Comparison (Arms 1 and 2) ( n = 50) ( n = 36) ( n = 14) Age in years
mean (range) 39.24 (18–56) 38.08 (±8.05) 42.21 (±10.40) .14 Race .31 White 33 (66.00%) 25 (69.44%) 8 (57.14%) Black 10 (20.00%) 7 (19.44%) 3 (21.43%) Hispanic 2 (4.00%) 2 (5.56%) 0 (0.00%) Other 5 (10.00%) 2 (5.56%) 3 (21.43%) Employment .2 Employed 35 (70.00%) 26 (72.22%) 9 (64.29%) Unemployed 3 (6.00%) 2 (5.56%) 1 (7.14%) Homemaker 7 (17.00%) 6 (16.67%) 1 (7.14%) Student 3 (6.00%) 2 (5.56%) 1 (7.14%) Retired 0 (0.00%) 0 (0.00%) 0 (0.00%) Disabled 2 (4.00%) 0 (0.00%) 2 (14.29%) Education .13 High school or less 4 (8.00%) 1 (2.78%) 3 (21.43%) College 24 (48.00%) 19 (52.78%) 5 (35.71%) Graduate school 20 (40.00%) 15 (41.67%) 5 (35.71%) Other 2 (4.00%) 1 (2.78%) 1 (7.14%) Marital status .29 Living alone 15 (30.00%) 10 (27.78%) 5 (35.71%) Living with spouse or partner 29 (58.00%) 23 (63.89%) 6 (42.86%) Other 6 (12.00%) 3 (8.33%) 3 (21.43%) Ever been pregnant 37 (74.00%) 27 (75.00%) 10 (71.43%) .79
Continuous variable compared with two-sided Student t test, categorical variables compared with chi-square test. Percents in parentheses are column percents.
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TABLE 2
UFS-QOL Results for All Patients
Mean (SD) Concern 14.08 (±5.19) Activities 17.82 (±6.88) Energy/mood 18.04 (±6.70) Control 13.32 (±5.23) Self-conscious 7.70 (±3.60) Sexual function 4.90 (±2.66) HRQL total (transformed on 0–100 scale) 59.60 (±20.65)
UFS-QOL, Uterine Fibroid Symptoms Quality of Life Index.
Higher scores on the six subscales indicate worse symptoms, but a higher score on the HRQL total reflects a better quality of life.
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TABLE 3
Mean Values (±SD) for Patient Experiences in Diagnostic Testing with TVUS and MR Imaging for Pelvic Symptoms
US MRI_P_ Value Wait Trade Off (weeks) 2.80 (±3.85) 3.56 (±3.86) .08 Testing Morbidities Index Fear or anxiety before 1.40 (±0.78) 2.16 (±1.15)<.0001 Pain before 1.44 (±0.70) 1.66 (±0.93) .15 Pain during 2.02 (±0.98) 2.18 (±1.13) .43 Embarrassment 2.04 (±1.19) 1.16 (±0.46)<.0001 Fear or anxiety during 1.46 (±0.79) 2.12 (±1.13)<.001 Mental status after 1.10 (±0.46) 1.48 (±0.95).02 Physical status after 1.06 (±0.23) 1.38 (±0.87).02 TMI summary utility (0–100) 87.42 (±12.29) 81.64 (±16.42).03
MR, magnetic resonance; TMI, Testing Morbidities Index, TVUS, transvaginal ultrasound.
Values are compared using paired t tests. Statistically significant comparisons are in bold.
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Discussion
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Acknowledgment
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