Page 73 - Diagnostic delay of endometriosis

Background
Endometriosis is a common gynaecological disorder, with a reported prevalence of 2-10% in women of reproductive age 1. It is defined as the presence of ectopic endometrial-like tissue which induces a chronic, inflammatory reaction 2. The clinical presentation is highly variable, ranging from asymptomatic to invalidating pelvic pain and infertility. Besides classic symptoms such as severe dysmenorrhoea, cyclic pelvic pain and dyspareunia, nonspecific or vague symptoms such as periodic bloating, diarrhoea or constipation, dysuria and fatigue are often presented as well 3,4. Some women respond well to symptomatic treatment by suppression of the menstrual cycle, however, a substantial number of women requires specialist consultation for diagnostics and treatment. Some patients experienced serious complaints that had not been addressed adequately for many years before eventually being diagnosed with endometriosis 5,6. Diagnostic delay remains an issue of great concern, because it may lead to delayed treatment or suboptimal care with risk of infertility, organ damage, reduced quality of life and loss of work productivity or disability 7,8. Previous studies have shown that the diagnostic delay in endometriosis is extensive and consists of several components related to both the patient and the doctor 6,7,9,10. The general practitioner (GP) plays a pivotal role in identifying patients at an early stage of the disease. Awareness on endometriosis as a possible underlying cause of abdominal complaints, facilitates empiric treatment or early referral if needed. In the Netherlands, GP education is based on a structured schedule of theoretical teaching combined with exposure in clinical practice. GPs in training are educated on gynaecological subjects in a short theoretical module in which endometriosis is scarcely addressed. Midwives and non-medical personnel are not involved in the care of gynaecological problems.
To be able to develop targeted interventions aimed at reducing diagnostic delay, it is crucial to be aware of determinants of daily general practice which may impede or facilitate early recognition of endometriosis. The aim of this study is to explore the barriers and facilitators influencing time to diagnosis of endometriosis from the GPs’ perspective.
Materials and Methods
Focus groups with general practitioners were performed between January 2016 and March 2017. Participants were recruited by contacting group
Barriers and facilitators to the timely diagnosis of endometriosis | 71