Pelvic Pain Connect study: a co-designed pre-pilot study to evaluate an interdisciplinary model of care for women with pelvic pain in a regional setting

A multi/interdisciplinary model of care for chronic pelvic pain. Multi/interdisciplinary care for chronic pelvic pain is best practice, as recommended by a recent systematic review from our team and international clinical practice guidelines. In this study, we will test the feasibility of an interdisciplinary model of care, based on the model of care in current practice at Royal Women's Hospital (RWH), in a regional setting, Northeast Health Wangaratta (NHW). The intervention will be provided by a team of clinicians representing different disciplines who work in pelvic pain clinics at RWH and NHW. This study will be conducted in three phases: Phase 1 will co-design the model of care; Phase 2 will deliver the model of care; Phase 3 will evaluate the feasibility of the model of care. Phase 1: -A co-design process; will involve team/stakeholder meetings, identification of needs of local service, resource sharing, mentoring of clinical skills and confidence gaps. We will have representation from 1 – 2 community-dwelling women with lived experience of pelvic pain (+/- diagnosis of endometriosis) in the co-design process. -We expect 4 – 6 NHW staff participants will participate. Clinicians who provide (or intend to provide) care in an interdisciplinary model of care (general practitioners, gynaecologists, nurses, physiotherapists, psychologists, dietitian) and administrative staff associated with the service will be invited. -The co-design process will be informed by an Australian experience-based co-design framework and the UK Medical Research Council framework for developing and evaluating complex interventions. - The frequency and duration of involvement: anticipated to be three 1 hour workshops delivered over a period of 3 weeks, email communications, development of a web-based portal with resources, - Phase 1 will occur prior to the intervention phase. It is anticipated to occur over a 4 week period. e.g. if Phase 1 starts in April 2026, Phase 2 would commence in May 2026. Phase 2: -Delivery of model of care to eligible NHW patients, expected to be 3 – 6 in the time frame of the study. These NHW patient participants with CPP will be referred to and eligible to enter the RWH clinical program. The exact clinical program delivered will be determined by the results of Phase 1, the co-design process. We expect a hybrid model of care will be developed, with a mix of face-to-face and telehealth consultations, with the option of on-site at NHW, and a hybrid of clinician care, with a mix of RWH-only, NHW-only and RWH-NHW co-consultation being delivered. We will start with a proposal of a model of care similar to the existing program delivered at RWH, but expect the co-design process may introduce some changes. The elements of model of care may be similar to the following TIDieR checklist: Brief Name: Interdisciplinary model of care for women with pelvic pain in a regional setting Why: Multi/interdisciplinary care for chronic pelvic pain is best practice, as recommended by a recent systematic review and international clinical practice guidelines . All patients, whether metropolitan or regional, deserve access to recommended best practice. What - Materials: RWH patient educational website (URL not available for public access) and education of regional clinicians informed by the co-design phase but likely to include resources and 1:1 mentoring. What - Procedures: 1. Introductory Nurse Phone Call (includes education about the program and access to online Early Intervention Pelvic Pain clinic portal resources [videos and written information]). 2. Clinical Care (Up to 2 pain specialist appointments, 4 physiotherapy appointments, 4 psychology appointments, 4 dietetics appointments and 3 phone calls with a nurse). - Pain specialist management may include medical assessment/investigation, referral to relevant medical specialties and allied health, education and pharmacological management. - Nursing management may include education and care-coordination. - Physiotherapy management may include pain science education, pelvic floor muscle exercises, bladder/bowel advice, relaxation strategies, breathing exercises, use of electrotherapy, lifestyle modification to avoid aggravating activities and pain flare-up self-management plan. - Psychology may include cognitive behavioural pain management, instruction in mindfulness, strategies to address psychological, social and relationship distress. - Dietetics may include education and dietary modifications, specific diet plans to treat gut symptoms. Who: A team of clinicians representing different disciplines who work in pelvic pain clinics at Royal Women's Hospital (RWH) and Northeast Health Wangaratta (NHW). This includes clinical disciplines of pain medicine specialist, pain nurse, physiotherapist, psychologist and dietitian. How: Face-to-face or via telehealth, 1-2 clinicians : 1 patient Where: Either in-person at Northeast Health Wangaratta (private consultation room), or via telehealth (HealthDirect platform). When and How Much: The program is delivered over a 4-6-month period of time. Introductory nurse phone call takes 20-30 minutes. Each appointment is up to 45 minutes long. Appointments are flexible but are typically scheduled fortnightly or monthly, depending on individual treatment plan. Nurse follow-up phone calls will occur periodically to check on patient progress. Tailoring: Individualised based on discipline specific assessment of patient needs. Modifications: NA How Well - Planned: Fidelity of delivery - EMR audit Fidelity of receipt and enactment - Semi-structured interviews. How Well - Actual: NA Phase 3: -Evaluation of model of care: All participants from phase 2 will be invited to complete the pre- and post-program evaluation surveys. The evaluation will focus on the outcomes of feasibility, acceptability, satisfaction, fidelity, health service usage and clinical outcomes. - All participants (patients and staff) will be invited to participate in a post-program interview to explore their experiences of the program. This will be conducted in a separate qualitative study from the program evaluation quantitative survey. - Interview details: Semi-structured interviews (approximately 1 hour in duration) will be conducted by a member of the research team experienced in the conduct of semi-structured interviews exploring patient and staff experiences of health services. Microsoft TEAMS platform will be used for patient and staff interviews. Interpreters will be used during the interview for NESB patient participants. Interviews will be audio-recorded and transcribed verbatim.