Page 102 - Diagnostic delay of endometriosis

The exact influence of guideline adherence on diagnostic delay is not known. It seems likely that knowledge of diagnosis- related items in the guideline may reduce diagnostic delay. However, evidence on the correlation between guideline adherence and diagnostic delay is lacking. Adopting clinical guidelines into routine daily practice requires interventions and effort at different levels. Analyses of barriers to changing practice have shown that obstacles can arise at the level of the individual professional, patient, health care team, health care organisation, or the wider environment. A good understanding of these barriers is very important.16, 17 Moreover, it is likely that other factors are important as well, since the diagnostic delay is still extensive despite the good adherence to the diagnosis-related recommendations by our respondents. It would be interesting to study whether the ESHRE guideline is well known amongst GPs as well, since the doctors’ delay is determined for a considerable part by the GPs.11
To our knowledge, this is the first study to report on factors contributing to diagnostic delay of endometriosis from the gynaecologist’s point of view. Although the respondents are well aware of the diagnostic delay and wish to reduce time to diagnosis, they under estimate the length of the delay by approximately one third. The same phenomenon is seen in Dutch GPs.12 Main factors contributing to diagnostic delay according to the gynaecologists are a lack of knowledge and awareness of endometriosis in both patients and medical professionals, as well as limitations in diagnostics and late referral to a gynaecologist. This observation is in line with previous studies.1, 3, 4, 18 There are subtle differences in contributing factors between the different types of medical professionals. The contributing factors for GPs are mainly aimed at knowledge and recognition, as for gynaecologists the proper use of diagnostics seems an important issue as well. Proposed interventions to facilitate early diagnosis are in part directed at these factors and include promoting patient awareness and participation, increasing knowledge in medical professionals and facilitating timely referral to a gynaecologist. Furthermore, the respondents suggest an improvement in collaboration between medical professionals. Although most respondents state they already collaborate with other hospitals, this is still one of the most frequently mentioned facilitating factors for gynaecologists. Suggested interventions include promoting referral to expert gynaecologists, improving collaboration with other medical specialists, for example surgeons and gastroenterologists, and facilitating the centralisation of endometriosis care. This is an interesting finding, since the suggested improvements in collaboration do not match
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