Quality standard

Quality statement 3: Discussing treatment options

Quality statement 3: Discussing treatment options

Quality statement

People with heavy menstrual bleeding have a discussion with their healthcare professional about all their treatment options. [2013, updated 2020]

Rationale

Discussing the full range of treatment options for heavy menstrual bleeding, including the benefits and risks of each option, enables the person to make an informed decision. It is important that the healthcare professional follows the principles in NICE's guideline on patient experience in adult NHS services on communication, information and shared decision making to maximise adherence to treatment and patient satisfaction.

Quality measures

Structure

Evidence of local arrangements to ensure that people with heavy menstrual bleeding have a documented discussion with their healthcare professional about all their treatment options.

Data source: Local data collection, for example service protocols.

Process

Proportion of people with heavy menstrual bleeding who have a documented discussion with their healthcare professional about all their treatment options.

Numerator – the number in the denominator who have a documented discussion with their healthcare professional about all their treatment options.

Denominator – the number of people with heavy menstrual bleeding.

Data source: Local data collection, for example audit of patient records.

Outcome

Proportion of people with heavy menstrual bleeding who report satisfaction with the decision‑making process when choosing treatment.

Numerator – the number in the denominator who report satisfaction with the decision‑making process when choosing treatment.

Denominator – the number of people with heavy menstrual bleeding.

Data source: Local data collection, for example audit of patient records.

What the quality statement means for different audiences

Service providers (such as hospitals, GP practices and community-based clinics) ensure that systems are in place for healthcare professionals to have documented discussions about the full range of available treatment options with people who have heavy menstrual bleeding.

Healthcare professionals (such as gynaecologists, GPs and nurses) carry out a documented discussion about the full range of available treatment options for heavy menstrual bleeding with the person and follow the principles in NICE's guideline on patient experience in adult NHS services on communication, information and shared decision making. The healthcare professional also takes into account the person's fertility preferences, any comorbidities, the presence or absence of fibroids (including size, number and location), polyps, endometrial pathology or adenomyosis, and other symptoms such as pressure and pain.

Commissioners (such as clinical commissioning groups and NHS England) ensure that they commission services to provide people with the full range of treatment options available for heavy menstrual bleeding.

People with heavy periods have a discussion with a healthcare professional about the full range of treatments available that could help and what they involve. They are supported by their healthcare professional to choose the right treatment for them.

Source guidance

Heavy menstrual bleeding: assessment and management. NICE guideline NG88 (2018, updated 2020), recommendations 1.4.1, 1.4.2, 1.4.7, 1.5.1 and 1.5.5

Definition of terms used in this quality statement

Discussion about treatment options

Discussions should cover:

  • the benefits and risks of the various options

  • suitable treatments if the person is trying to conceive

  • whether the person wants to retain their fertility and/or uterus.

A full discussion is essential when people are considering hysterectomy and should include the implications of surgery. Surgical options including hysterectomy can be offered if treatment is unsuccessful, the person declines pharmacological treatment or symptoms are severe. [Adapted from NICE's guideline on heavy menstrual bleeding, recommendations 1.4.2, 1.4.7 and 1.5.5, NHS England's evidence-based interventions programme and the NICE endorsed shared decision making aid for heavy menstrual bleeding]