Page 101 - Diagnostic delay of endometriosis

Organisation of care in the Netherlands
Multi-disciplinary teams were operative in 35 of the 67 participating hospitals (52%). The teams consist of gynaecologists collaborating with a surgeon (31/35), radiologist (27/35), urologist (26/35), gastroenterologist (12/35), pain specialist (13/35), and/or a psychologist (13/35). Less frequently other medical professionals were involved including dieticians (4/35), pelvic floor physiotherapist (4/35), sexologist (4/35), medical social worker (2/35) and/ or continence or stoma nurse (2/35). Surgery for deep endometriosis was performed in 35 of the 67 hospitals (52%) and 30 out of these 35 hospitals (86%) had multi-disciplinary teams.
Collaboration
Most respondents state that they collaborated with other hospitals (n=62). Collaboration consists of regular contact by phone or email and referral. The majority refers patients (n=55), 29 hospitals receive patients referred from others. The main reasons for referrals are insufficient effect of an applied treatment (n=40), requiring surgery (n=42) and subfertility concerns (n=25), especially in women with deep endometriosis.
Centralisation
A majority of respondents (n=41, 61%) is in favour of centralisation because of the complexity of the disease, and to improve quality of care and to promote (interdisciplinary) cooperation. According to the gynaecologists, expert clinics could be established from regional collaborations in which a multidisciplinary approach, high volume in new patients and experiences with complex surgery, scientific research and level of patient satisfaction guiding the allocation of these clinics. Many of the respondents who oppose to centralisation state that less severe cases do not require centralized care.
Discussion
The ESHRE guideline ‘Management of women with endometriosis’ seems overall well known and applied by the respondents; 99-100% of participants in the study agrees with, and 91-100% adheres to the diagnosis-related recommendations in the ESHRE guideline. However, diagnostic delay is still a large concern in endometriosis in which a variety of factors may play a role. There are no comparable studies from other countries about adherence to the ESHRE guideline. This could provide interesting information on differences and possible opportunities for improvement.
Gynaecologists’ view on diagnostic delay and care performance | 99