Quality statement 5: Discussing treatment options

Quality statement

Women with heavy menstrual bleeding have a documented discussion about all recommended treatment options.

Rationale

It is important that all women have the opportunity to discuss the treatment options available to them. Understanding the risks and benefits of various options gives them choice and enables them to make an informed decision about which treatment is most appropriate for them.

Quality measures

Structure

a) Evidence of local arrangements that women with heavy menstrual bleeding have a documented discussion about all recommended treatment options.

Data source: Local data collection.

b) Evidence that service providers have networks in place to refer women if their choice of intervention is not provided locally.

Data source: Local data collection. The National heavy menstrual bleeding audit includes an organisational audit to establish provision of treatment options (see section 4 in the first annual report of the National heavy menstrual bleeding audit). These data may inform a baseline assessment.

Process

The proportion of women with heavy menstrual bleeding who have a documented discussion about all recommended treatment options.

Numerator – the number of women in the denominator who have a documented discussion about all recommended treatment options.

Denominator – the number of women with heavy menstrual bleeding.

Data source: Local data collection. The National heavy menstrual bleeding audit includes an analysis of patterns of surgical treatment for women with heavy menstrual bleeding (see section 3 and appendix 3 in the first annual report of the National heavy menstrual bleeding audit). These data may inform a baseline assessment.

Outcome

Women's satisfaction with the decision‑making process when choosing treatment for heavy menstrual bleeding.

Data source: Local data collection. The National heavy menstrual bleeding audit includes an analysis of women's self-reported experiences of the secondary care they received. The analysis includes the elements 'information received and satisfaction with information received', 'communication with doctors in secondary care' and 'overall rating of care received' (see section 7 in the third annual report of the National heavy menstrual bleeding audit). These data may inform a baseline assessment.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers ensure that systems are in place for women with heavy menstrual bleeding to have a documented discussion about all recommended treatment options.

Healthcare professionals ensure that women with heavy menstrual bleeding have a documented discussion about all recommended treatment options.

Commissioners ensure that they commission services with local agreements for women with heavy menstrual bleeding to have a documented discussion about all recommended treatment options.

What the quality statement means for patients and carers

Women with heavy menstrual bleeding discuss all recommended treatment options with their doctor.

Source guidance

Heavy menstrual bleeding: assessment and management (2018) NICE guideline NG88, recommendation 1.4.2

Definitions of terms used in this quality statement

Documented discussion

The discussion should be between the woman and the relevant doctor. It should reflect the advice in section 1.5 of NICE's guideline on heavy menstrual bleeding and cover:

  • the benefits and risks of the various options

  • suitable treatments if she is trying to conceive

  • whether she wants to retain her fertility and/or her uterus.

This discussion should be documented in the woman's notes. Written information about the different treatment options should be given to the woman.

Recommended treatment options

Treatments as outlined in section 1.5 of NICE's guideline on heavy menstrual bleeding.

Equality and diversity considerations

Women from all socioeconomic backgrounds should have equal access to information about their treatment options.