From unrelenting knee pain to debilitating bleeding, from surprise incontinence to the frustration of weight management, chronic health issues can be exhausting and, at their worst, rob women of living to the best of their ability.

Quality (of Life) Control

At Magee-Womens Research Institute (MWRI) and UPMC Magee-Womens Hospital, clinical researchers are studying communication methods and treatment protocols that explore improving quality of life for women with a variety of conditions that, while not life-threatening, can very much threaten quality of life. It’s a concept Nicole Donnellan, MD, director of the Center for Endometriosis and Chronic Pelvic Pain at Magee and MWRI researcher, uses often.

“At our center, we see patients with bleeding and pain so debilitating they can’t get out of bed some
days,” said Dr. Donnellan. “They also sometimes experience endometriosis- related infertility. They have pain with relieving themselves, pain during sex. Pelvic pain and endometriosis can affect all facets of their lives. The surgery I do isn’t necessarily life- saving, but what does your life look like without treatment?”

The difficulties in diagnosing pelvic pain and endometriosis, combined with the all-too-common treatment delays women experience, propelled Dr. Donnellan to spearhead the creation of the center, which seeks to improve early diagnosis and treatment of pelvic pain disorders and advance research progress for the condition. The clinic embraces a unified team approach to patient care, providing patients with the opportunity to meet with gynecologists, psychiatrists, physical therapists and surgeons during the same visit.

“There are so many elements that contribute to pelvic pain conditions,” said Dr. Donnellan. “Many women have been told for years their pain is all in their head, others have undergone unnecessary treatments or had poor pain management. Others have been completely dismissed. The opportunity to meet with a comprehensive team of pelvic pain experts, who work together in developing a diagnosis and treatment plan, is a huge relief to these women.”

An extension of the center is the Chronic Pelvic and Bladder Pain Clinic at the UPMC Lemieux Sports Complex in Cranberry, Pennsylvania. The clinic, which opened at the beginning of April 2021, already is outgrowing its capacity. It offers medical intervention, including physical therapy as well as cognitive and behavioral health services.

Patient feedback about the clinic has been overwhelmingly positive, according to Pamela Moalli, MD, PhD, director of the Division of Urogynecology & Pelvic Reconstructive Surgery. And that, in turn, has been gratifying for the clinic’s staff.

Another of the division’s key initiatives is the new MOMMA Postpartum Healing Clinic, which opened in November 2020 and offers focused consultation for women with injuries related to childbirth. (The name comes from StreaMlining and OptiMizing Maternal pelvic floor health after childbirth.)

Because pelvic floor prolapse and stress urinary incontinence are so closely linked to maternal birth injury, Dr. Moalli’s hope is that the clinic’s more proactive approach will have a positive impact on patients later in life.

“To me, understanding the pathophysiology so we can implement preventive measures is really the key to the puzzle,” she said.

“That, we believe, will put Magee at the forefront in reducing maternal birth injury and, as a result, future pelvic floor disorders.”

Raising the Bar

According to Anthony DiGioia, MD, coordinator of the new Center for Bone and Joint Health (CBJH) at UPMC Magee-Womens Hospital, there is now a much higher expectation from patients to actively live longer and better. To support these patient goals, the new collaborative center leverages the interdisciplinary community of practice at Magee, which includes the Midlife Health Center, Osteoporosis Care, Bariatrics and Nutritional Support, Pain Management, and Western Wellness Mental Health Services.

The CBJH rooted its mission and goals in themes directly derived from patient feedback and research in musculoskeletal care. The Center seeks to identify and address health disparities with a focus on early evaluations and ‘personalized care’, which is developed by co-designing with patients and communities to better address their needs.

But personalized care alone is not enough. Patients, providers, and community members must also be educated about the importance of caring for your bone and joint health in living an active lifestyle longer, as well as disparities and risk factors correlated with gender, race socioeconomic status, and others.

“Education is a key component of our mission. Education of the community, patients, and providers, especially when it comes to gender- specific health disparities.”
DR. ANTHONY DIGIOIA

Clinical staff agree that listening to their patients is a key element in improving a patient’s health condition and her overall wellness.

Dr. DiGioia and the Magee collaborators use a listening tool called “What Matters To You?” (WMTY) to understand each patient’s priorities and set treatment goals based on those indicated priorities.

“We have to understand our patients’ needs – what a good quality of life looks like to them,” said Dr. DiGioia.

“Do they want to be able to play on the floor with their grandchildren or run a marathon? Those are very different needs and could require different treatment plans.”

According to Dr. DiGioia, there are
a wide variety of factors that come into play when it comes to caring for women. Women tend to postpone evaluations because they put other family members ahead of themselves. They handle and process pain differently, and even certain muscle groups behave differently in women than in men.

Dr. DiGioia and the members of his team encourage patients to consid-
er their health and wellness beyond what’s happening with their condition, be it arthritis, osteoporosis or some- thing else. The program process be- gins with multiple phone calls, incor- porating “What Matters to You?” and motivational interviewing, which invite patients to consider their readiness to change and address any barriers that might affect progress. From the goals patients indicate, a personalized treatment plan is created.

Guided by the patients’ priorities in the treatment plan, the CBJH connects other services and support that address the at-times complex and overlapping health needs. For example, patients with arthritis may require nutritional support to improve their dietary health as well as screening for osteoporosis with a bone density scan. Throughout the process, patients check in with the CBJH coordinator, who provides accountability and support as patients move toward meeting their goals.

“Co-morbidities affect pain. Smoking, your body-mass index, depression, anxiety — these are all known factors we now work to address in advance of any surgery. We embrace a whole person health approach, which puts patients in the driver’s seat and surrounds them with services and support to influence improved health outcomes,” said Dr. DiGioia.

Thinking Outside the Clinic

John Harris, MD, a principal investigator with Magee-Womens Research Institute (MWRI) and director of the Center for Women with Disabilities at UPMC Magee- Womens Hospital, has witnessed first-hand how obesity impacts the care women receive over the course of their lifetimes.

“There is this idea that weight is completely under your control, and it’s simply not true,” said Dr. Harris.

“For women with obesity, I believe we should ensure we are providing the very best possible care on every other front of healthcare. Let’s make sure we do everything else extraordinarily well.”

“Cures – completely solving a medical problem – are fairly rare. Learning to ask better questions, to really hear the patient and what matters to them, makes a longer-lasting, day-to-day impact than almost anything else.
Dr. John Harris

Like the centers led by Drs. Donnellan and DiGioia, the Center for Women with Disabilities takes a holistic approach to caring for patients. Whether they are facing physical or intellectual disabilities, or a combination, patients who visit the clinic are guaranteed their woman- specific care will be the priority.

“As a physician, I want to know my patients are living their best lives, so I encourage them to try eating healthier and being more active. The truth is people really struggle to lose weight — we need to find other ways to help them,” said Dr. Harris.

For patients and clinicians, the commitment needed to improve chronic conditions can often be challenging and results can feel incremental.

“Physicians are very solution-oriented,” said Dr. Harris. “We want to help people, to solve problems. But not every patient can be fixed with a procedure or medication. Chronic care requires a special dedication,and patients grow frustrated. It requires humility from providers and from patients.”

The centers’ treatment approaches are informed by research designed to improve physician-patient communication and treatment outcomes. “Cures — completely solving a medical problem – are fairly rare,” said Dr. Harris. “Learning to ask better questions, to really hear the patient and what matters to them, makes a longer-lasting, day-to-day impact than almost anything else. Quality of life is a spectrum. A small shift or a large shift toward a better quality of life is an improvement that changes people’s lives every day.”