Page 95 - Diagnostic delay of endometriosis

Guideline adherence
Almost all respondents were familiar with the guideline ‘Management of women with endometriosis’ (n=65, 97%). The agreement with and adherence to the individual key recommendations are shown in Table 2.
The key recommendations in the diagnostic domain were overall well known and applied. Agreement with the recommendation ‘Assess ureter, bladder and bowel involvement by additional imaging if there is a suspicion based on history or physical examination of deep endometriosis, in preparation for further management’ was high; however, 15 gynaecologists (22%) do not consistently operate according to this recommendation.
Regarding the treatment of endometriosis-related pain, a high number of gynaecologists agreed with the following recommendations: ‘Prescribe hormonal add-back therapy to coincide with the start of GnRH agonist therapy, to prevent bone loss and hypoestrogenic symptoms during treatment’ (82%), ‘Surgically treat endometriosis when identified at laparoscopy, i.e. ‘see and treat’, as this is effective for reducing endometriosis-associated pain’ (84%) and ‘Refer women with suspected or diagnosed deep endometriosis to a centre of expertise that offers all available treatments in a multidisciplinary context’ (93%). However, fewer gynaecologists typically operate according to these recommendations (67%, 75% and 78% respectively).
The agreement on the recommendations for treatment of endometriosis- associated infertility appears to be quite high (84-96%) and most of the gynaecologists apply them in practice (84-93%).
In the miscellaneous topics, agreement was high on the recommendations ‘Continue to treat women with a history of endometriosis after surgical menopause with combined estrogen/progestagen or tibolone, at least up to the age of natural menopause’ (90%) and ‘Fully inform and counsel women about any incidental finding of endometriosis’ (88%), whereas these recommendations were less often applied (82% and 78% respectively). The last recommendation ‘Inform women with endometriosis, requesting information on their risk of developing cancer that (i) there is no evidence that endometriosis causes cancer, (ii) there is no increase in overall incidence of cancer in women with endometriosis and (iii) some cancers (ovarian cancer and non-Hodgkin’s lymphoma) are slightly more common in women with endometriosis’ scored lower on both agreement (76%) and appliance in practice (52%).
Gynaecologists’ view on diagnostic delay and care performance | 93