Page 171 - Diagnostic delay of endometriosis

the diagnostic delay. The key recommendations from the most recent ESHRE guideline were overall well known; 99-100% of respondents agreed with and 91-100% adhered to the diagnosis-related recommendations in the guideline. Median diagnostic delay was estimated at 42 months by the gynaecologists, which is substantially lower than the delay of 89 months provided by patients. Main factors contributing to diagnostic delay according to gynaecologists are lack of knowledge and awareness of endometriosis in both patients and medical professionals, as well as limitations in diagnostics and late referral. Suggested interventions to reduce diagnostic delay are aimed at improving knowledge and awareness in both patients and medical professionals, as well as improving collaborations between medical professionals.
In the fourth part of the thesis, future efforts to reduce diagnostic delay of endometriosis are discussed in chapter 7. Relevant barriers and facilitators from the previous chapters were incorporated into a list of potential interventions to reduce diagnostic delay and presented to an expert panel in a Delphi study. The expert panel consisted of patients (n=26) and professionals (n=55, of which 23 general practitioners, 26 gynaecologists and 6 miscellaneous professionals). They rated and prioritized 36 interventions in four consensus rounds resulting in a set of 10 key interventions. The selected interventions were mainly directed at improving knowledge and awareness in medical professionals by increasing education for medical students, trainees and medical specialists including general practitioners, gynaecologists and other medical specialists encountering women in their reproductive life span (n=7). The other three selected interventions advocate expanding research directed at non-invasive diagnostic tests, the development of a multidisciplinary national guideline concerning menstrual complaints including indications for referral, and the development of a decision aid for the diagnostic process. This set of key interventions is supported by a wide diversity of stakeholders in the field. Analysis of the consensus procedure revealed subgroup preferences for a number of interventions, which although these interventions did not make it to the final selection, they may be of potential interest for improving endometriosis awareness and medical care in specific settings. The results of this study can serve as input for a multifaceted intervention strategy aimed at optimizing help seeking behavior of women with symptoms suggestive of endometriosis, and improving knowledge and clinical strategies in medical professionals.
Summary | 169