162 Chapter 11 IMPACT PARAGRAPH Research This thesis has investigated the optimization of diagnostic pathway for women with HMB and underlying bleeding disorders within gynaecology. It focuses on interdisciplinary communication and a patient-centered approach to enhance the diagnostics process. The studies included in this thesis demonstrate that the use of semiquantitative measurement methods, including the validated International Society on Thrombosis and Haemostasis bleeding assessment tool ([ISTH] BAT) and self-admitted standardized questionnaire (the self-BAT), can be used as an interdisciplinary link between the gynaecology-haematology clinic during the diagnostic process of HMB and underlying bleeding disorders in women. Although the FIGO definition “HMB is excessive bleeding that interferes with a woman’s physical, emotional, social and material quality of life and may occur alone or in combination with other symptoms” is intended to be empowering and stimulating, its amorphous nature means that it can only be used effectively by physicians who are comfortable and skilled in identifying HMB and have the openness and ability to prioritize this aspect of women’s health. This thesis shows that adding a free-text response option to the self-BAT, and an art-based narrative medicine approach in the gynecologic workplace, can promote awareness and knowledge sharing among clinicians. This could make a huge practical difference to the challenges faced by women and girls with bleeding disorders. However, we do advise better documentation of the long-term effects and lessons learned. Regarding the self-BAT, and an art-based narrative medicine approach delivery process and the work floor dynamics involved, we hope to better understand what works, for whom and in which contexts. We recommend focusing on the interdisciplinary diagnostic process to identify where contact with other professionals and knowledge sharing is most important for women with bleeding disorders. Incorporating patients’ perspectives through free-text responses in questionnaires, like the self-BAT, empowers patients, improves the understanding of healthcare professionals, and leads to more patient-centered care approaches. Relevance The prevalence of HMB is estimated at 15% to 61% of all those who menstruate [1]. Of women with bleeding disorders, HMB is experienced between 80% and 91% [2, 3]. This broad range reflects the difficulty in accurately defining, analyzing, and interpreting HMB. Therefore, the diagnostic work up of HMB requires a multifaceted approach that should be centered on actively listening to and believing women when they articulate symptoms of HMB, like social impact, fatigue and/or anemia [4, 5]. Additionally, this management partnership entails investigating the root cause, like bleeding disorders and what diminishes iron availability [6]. Interestingly, awareness among gynecologists/obstetricians about bleeding disorders as a cause of HMB is low [7, 8]. In 2012, a survey by the American College of Obstetricians and Gynecologists
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