137 General discussion and future perspectives with HMB. One of the barriers to open discussion is the often-unspoken shame women can feel about this sensitive subject. A recent study that evaluated thousands of social media posts on the topic of menstruation in young women found three themes across all posts: menstrual health, period stigma, and menstrual positivity [27]. Of these themes, the most important were the negative expectations and shame surrounding menstruation. Health care providers who deal with patients who experience HMB and/or coagulation problems should be aware of these stigmas. So, how can we improve interdisciplinary care for those women with HMB and especially those with bleeding disorders [36]. To bridge interdisciplinary knowledge and awareness gaps, a hermeneutic phenomenology method can be used. This method interweaves vivid descriptions of lived experiences (phenomenology) together with reflective interpretations of their meanings (hermeneutics) [37]. Hermeneutic phenomenology often turns to the poetic for a suitably evocative language capable of bringing forth the richness of lived experience [38]. Therefore, in our study we used site-specific poetry as a ‘third eye’. Interdisciplinary participants were reached out to express their feelings and experiences about complex and inequality themes like ‘Heavy menstrual bleeding’ [39, 40]. Moreover, interprofessional collaborative practice increases high quality of care in healthcare teams [41]. In chapter 7 we describe the process of a co-created site-specific poem with Ramsey Nasr based on the discussions we had with patients in the context of taboo topics in the health care system, and a literature review of the role language plays in meaning-making. This poem was used in a narrative medicine (NM) training on the obstetric-gynecological (OB-GYN) work floor. An art-based NM approach is a intervention based on hermeneutic phenomenology to discuss complex problems and healthcare experiences [42].The narratives that emerged were powerful and reflect the physical, emotional, and social impact of stigmatization. The participants stated that they found the NM approach with the use of the poem very useful in facilitating conversations about taboo topics such as “heavy menstrual periods”. Participants experienced that the lyrics can be interpreted in different ways and are connected to their own professional experiences. Participants discovered that a poem could help them see their daily work in a new light and to connect with each other. As a model for a tailored arts-meets health education, site-specific poetry, like visual art or music, is a powerful intervention to enhance patient-centered communication in the health care context and professional roles, identity or job satisfaction [43, 44]. Based on our study (chapter 7) a site-specific art-based NM intervention on the OB-GYN work floor can yield valuable information on how to structure future health care to create a meaningful improvement in knowledge about complex and inequality themes and professionals’ well-being. Nevertheless, better documentation of the long-term effects and lessons learnt, regarding the art-based NM intervention delivery process and the work floor dynamics involved, are needed to better understand what works, for whom and in which contexts. Future studies should firstly focus on the interdisciplinary diagnostic process to determine where in the process contact with other professionals and sharing knowledge is utmost important for these women with bleeding disorders. Second, a uniform European patient-centered flow-chart of these crucial communication steps should be considered. 8
RkJQdWJsaXNoZXIy MTk4NDMw