Prevalence of and risk factors for endometrial polyps among asymptomatic postmenopausal women with uterovaginal prolapse.

BACKGROUND: The prevalence of endometrial polyps among asymptomatic, postmenopausal women is not well defined. There is no clear clinical consensus on how to manage endometrial polyps in this population and whether these polyps truly are a cause for clinical concern. OBJECTIVE: This study aimed to estimate the prevalence of endometrial polyps among asymptomatic (without bleeding), postmenopausal women and to evaluate risk factors associated with their presence. STUDY DESIGN: This cross-sectional study assessed the prevalence of endometrial polyps among asymptomatic, postmenopausal women who underwent a hysterectomy for uterovaginal prolapse. Patients were excluded if they underwent a hysterectomy for other indications, including postmenopausal bleeding. Following chart review, eligible patients who received care at a single site in Washington state from 2009 to 2018 were included. The primary outcome was the presence of endometrial polyps on pathology. Risk factors associated with polyp prevalence were subsequently assessed using univariate analysis and multivariate regression. RESULTS: Of the 317 eligible women identified, endometrial polyps were identified in 106 women (33.4%). The average polyp size and endometrial thickness was 13±10 mm and 1.4±1.5 mm, respectively. Most cases (78%) had solitary polyps. Premalignant and malignant lesions were found in 2 cases (1.89%); 1 had endometrial carcinoma and 1 had endometrial intraepithelial neoplasia. Baseline clinical and demographic characteristics were similar between patients with and those without endometrial polyps, including the presence of fibroids, endometriosis, and adenomyosis. A multivariate logistic regression showed that the presence of polyps was independently associated with a high body mass index (odds ratio, 1.06; 95% confidence interval, 1.01-1.12; P=.02) and use of menopausal hormone therapy (odds ratio, 1.67; 95% confidence interval, 1.02-2.72; P=.04). CONCLUSION: Asymptomatic postmenopausal women who underwent hysterectomy for uterovaginal prolapse exhibited a high prevalence of endometrial polyps. Those who used menopausal hormone therapy and who had a high body mass index were at a higher risk for developing endometrial polyps. Although the risk for malignancy seems to be low, more investigation is warranted to truly quantify the lifetime risk. For now, expectant management may be a reasonable approach for incidentally found, asymptomatic polyps.

Care Transitions From Patient and Caregiver Perspectives.

PURPOSE: Despite concerted actions to streamline care transitions, the journey from hospital to home remains hazardous for patients and caregivers. Remarkably little is known about the patient and caregiver experience during care transitions, the services they need, or the outcomes they value. The aims of this study were to (1) describe patient and caregiver experiences during care transitions and (2) characterize patient and caregiver desired outcomes of care transitions and the health services associated with them. METHODS: We interviewed 138 patients and 110 family caregivers recruited from 6 health networks across the United States. We conducted 34 homogenous focus groups (103 patients, 65 caregivers) and 80 key informant interviews (35 patients, 45 caregivers). Audio recordings were transcribed and analyzed using principles of grounded theory to identify themes and the relationship between them. RESULTS: Patients and caregivers identified 3 desired outcomes of care transition services: (1) to feel cared for and cared about by medical providers, (2) to have unambiguous accountability from the health care system, and (3) to feel prepared and capable of implementing care plans. Five care transition services or provider behaviors were linked to achieving these outcomes: (1) using empathic language and gestures, (2) anticipating the patient's needs to support self-care at home, (3) collaborative discharge planning, (4) providing actionable information, and (5) providing uninterrupted care with minimal handoffs. CONCLUSIONS: Clear accountability, care continuity, and caring attitudes across the care continuum are important outcomes for patients and caregivers. When these outcomes are achieved, care is perceived as excellent and trustworthy. Otherwise, the care transition is experienced as transactional and unsafe, and leaves patients and caregivers feeling abandoned by the health care system.

Experiences and Perspectives on Advance Care Planning among Individuals Living with Serious Physical Disabilities.

BACKGROUND: Despite frequent encounters with the healthcare system and high risk for secondary conditions, it is unclear how frequently individuals living with serious physical disabilities document advance directives (AD) or engage in advance care planning (ACP). Their perspectives on these topics are largely unknown. OBJECTIVE: We aimed to characterize the perspectives of individuals with serious physical disabilities receiving care from two different healthcare delivery settings on the value of AD and ACP. DESIGN: Key informant interviews were conducted, audiorecorded, transcribed, and analyzed using thematic analysis and constant comparative analysis. SUBJECTS: Twenty-five adults with serious physical disabilities were interviewed. RESULTS: Five organizing themes emerged as follows: (A) AD is a right versus responsibility, (B) past medical experiences influence ACP engagement, (C) ACP requires relationship-centered decision support, (D) concerns for care after death, and (E) suggestions for improving ACP experiences. Participants wished to engage in a relationship-centered approach to ACP, yet voiced hesitation due to experiences of significant medical bias and mistreatment, typically surrounding judgments of their quality of life. CONCLUSIONS: Better health professional training in ACP and heightened awareness of the unique ACP considerations pertaining to people with disabilities are recommended.