Pratik Shukla, MD, interventional radiologist at Rutgers University, contributed this piece.
Fibroid Awareness Month is held annually in July. The observance provides an opportunity to raise awareness for uterine fibroid embolization (UFE), discuss socioeconomic disparities in referral patterns, and share actionable approaches to positively impact access to high-quality care. I had the opportunity to discuss health equity pertaining to UFE during a recent American College of Radiology® (ACR®) Bulletin Podcast and look forward to sharing highlights from our episode below.
Before we can understand socioeconomic disparities pertaining to uterine fibroids, we must first understand the condition. Fibroids are benign tumors of the uterus in response to hormonal changes during the menstrual cycle. The tumors have the capability to grow over a long period of time, causing a high variability of symptoms which can include but are not limited to heavy menstrual bleeding, signs of anemia, pressure or pain in the pelvis and nerve pain. Treatment options include surgical intervention such as hysterectomy or myomectomy, or alternatively, UFE — a minimally invasive procedure performed by interventional radiologists (IR). Patients who undergo this procedure experience improved symptoms over the course of three to six months and can return home the same day and resume activities in a few short days, all with minimal risk.
However, access to high-quality care isn’t possible for all patients. Disparities in equity stem from several factors, including referral patterns, economic and educational challenges. Despite efforts to educate physicians (i.e. OBGYN) and using traditional marketing strategies (i.e. social media), we still find barriers to patient awareness. In our ongoing study with preliminary results presented at the 2022 Annual Society of Interventional Radiology (SIR) meeting, we demonstrated a majority of patients who underwent hysterectomy who participated in our survey had no or little knowledge of UFE as a treatment option for symptomatic uterine fibroids. Furthermore, the patients who had knowledge of the procedure were given various reasons against it rather than being offered a consultation with an interventional radiologist. These findings bring into question the process of informed consent, which includes benefits, risks and alternatives for any treatment option.
Another study we conducted years ago which was also presented at SIR evaluated referral patterns with our UFE patients. We noticed that a majority of referral were made for underinsured patients – (defined as Medicaid, charity or no insurance) which did not reflect the distribution of insurance for patients in the surrounding community – an underserved and underrepresented community. We partnered with a suburban hospital and affiliate medical school to perform the same analysis on their referrals and were surprised to find that their distribution of insurance reflected that of the surrounding community. Usually, underinsured patients lack access to minimally invasive procedures. However, these are the dominant referrals in our underserved community.
Moving forward, our collaboration with the Radiology Health Equity Coalition (RHEC) will allow us to partner with healthcare economists to perform these studies with larger databases from patients in communities across the nation.
In addition to these studies, patient advocacy plays a critical role in the advancement of health equity. Interventional radiologists can continue to educate referring physicians and patient outreach efforts. In our population, we have noticed that patients may not have access to traditional educational tools, such as social media, and also have poor health literacy. We have noticed that placing boots on the ground and literally meeting people in the community via health fairs and community events has increased awareness. However, this endeavor requires many resources and time. We are now trying to form partnerships who also believe in the cause of improving access to healthcare to help with this endeavor including patient support groups and groups with similar goals such as the RHEC. We are attempting to partner with the medical school for grants to support such endeavors as well. The University Hospital is partnering with local politicians to strategize on ways to reach our patient population. On the flip side, many of my IR colleagues across the nation are working with government officials in tackling the issue of commercial insurance coverage for UFE.
Finally, this patient-friendly video created by the ACR Commission on Patient- and Family- Centered Care helps patients better understand fibroids and participate in shared decision making with their physicians. Consider sharing this resource with your patients and/or referring providers.