Page 170 - Diagnostic delay of endometriosis

Facilitating factors for a timely referral were a desire for pregnancy, the disclosure of specific symptoms related to the menstrual cycle, and persistence in requesting referral. Suggested interventions to reduce diagnostic delay in endometriosis were directed at increasing awareness in the general population, and providing medical staff (in particular general practitioners) with sufficient knowledge and skills to interpret presented symptoms or clinical findings correctly.
The second part of the thesis starts with a questionnaire study to evaluate the knowledge and clinical strategies of general practitioners in chapter 4. The 101 participating general practitioners appeared to underestimate the diagnostic delay of endometriosis, in particular the proportion in primary care. The results of the questionnaire indicated that if the general practitioners considered endometriosis as a possible diagnosis, adequate action was undertaken. However, since the prevalence rate of endometriosis was highly underestimated, they did not seem to recognize the symptoms that may be caused by endometriosis in all women. The focus group study presented in chapter 5 provides more detailed understanding of barriers and facilitators to a timely diagnosis of endometriosis in primary care. Six focus group sessions, in which 43 general practitioners participated, revealed relevant determinants of practice in four themes: professionals’ experience and competence, patient characteristics, guideline factors and professional collaboration. Limited knowledge and awareness and the lack of an appropriate guideline appeared to result in a low priority for establishing the diagnosis of endometriosis. The general practitioners felt that definite diagnosis is not always beneficial, since it may induce a burden of disease or “stigma” to some women. Furthermore, the general practitioners feared the inappropriate use of invasive techniques. Infertility, patient assertiveness and a recent training or serious case were facilitating factors for referral. The general practitioners unanimously preferred more collaboration with gynaecologists about indications and instructions for empirical or first line treatment and timing of referral. They were in favour of the development of a new national guideline in which up to date recommendations with regard to the use of diagnostic tests, empirical treatment and indications for referral to a gynaecologist are provided.
The third part of the thesis is directed at the gynaecologists’ view on diagnostic delay of endometriosis. Chapter 6 presents a nation-wide questionnaire study which focussed on current care performance and gynaecologists’ opinion on
168 | Chapter 9