Concerns and Goals of Women with Isolated Mesh-Associated Pain Syndrome Accessing a Quaternary Mesh Referral Service: A Thematic Analysis.

Abstract

<h4>Introduction and hypothesis</h4>Isolated mesh-associated pain syndrome (I-MAPS) is the commonest reason why women access mesh-complication services. Qualitative work exploring expectations of women with I-MAPS is limited. We aimed to explore the concerns and goals of women with I-MAPS who accessed care at a quaternary-level mesh service to ensure that services are designed to meet their needs.<h4>Methods</h4>A total of 280 women with I-MAPS related to a single continence device, were invited to provide free-text comments on concerns and goals related to their mesh complication using the Electronic Patient Assessment Questionnaire (e-PAQ). Of 280 participants, 203 completed the e-PAQ (response proportion 73%) and 179 (response proportion 64%) provided comments. Thematic analysis was performed based on the methodology proposed by Braun and Clarke.<h4>Results</h4>Thirty-eight codes were developed, and 109 sub-codes. These defined eight core themes. Concerns regarding pain accounted for 22% of comments (106 out of 489). Concerns about pelvic floor symptoms featured heavily in comments. Symptom resolution was desired by most; however, a proportion requested symptom reduction. Mesh-removal surgery was a common goal pursued; however, a proportion wished information about the safety and future threat of mesh devices.<h4>Conclusions</h4>Patients with I-MAPS appear to have concerns unrelated to pain including pelvic floor dysfunction and these may be the primary motivation for accessing mesh services. Although mesh removal was a motivation for many, it was not requested by all. This highlights the importance of services offering individualised and holistic care through multidisciplinary team involvement.