Page 28 - Diagnostic delay of endometriosis

Women presenting with subfertility will be referred to a gynaecologist. Women presenting with abdominal pain may also be referred to other specialists like a surgeon or urologist. In this study, we investigated the time taken to make a diagnosis of endometriosis in a Dutch population of women treated in a secondary care centre. Second, we identified factors contributing to diagnostic delay. Eventually, we aimed at improving the care for women with endometriosis by minimizing the time to diagnosis.
Materials and Methods
Data Collection
In this retrospective study, all patients who were diagnosed with endometriosis by surgery or MRI in Rijnstate hospital Arnhem between March 2012 and April 2014 were selected (n = 139). Rijnstate is a secondary referral centre, specialized in multidisciplinary treatment of endometriosis. It is recommended by the Dutch endometriosis society, the endometriosis patient interest group. In our study, age younger than 18 or insufficient understanding of the Dutch language was the exclusion criterion. Patients were informed by mail and, after consent, administered a telephonic questionnaire in May or June 2014. A 15-item questionnaire, developed by XS and AN, incorporated questions about the time of onset of symptoms, time to consultation of their GP, time to referral to a second-line medical specialist, and time to diagnosis. Data were completed with documentation from the patient record. Other questions regarded symptoms, treatment received from the GP, other diagnoses that were considered, and indication for referral. Type of endometriosis was determined by review of the operation reports or the MRI report.
Analysis
Statistical analysis was performed using IBM SPSS Statistics (IBM Corp, Armonk, N.Y., USA). Mann–Whitney U test, Pearson’s correlation and Fisher’s exact test were used to analyze the data. A p value <0.05 was considered statistically significant. Patients were subdivided in separate groups based on the duration of diagnostic delay by GP and by the gynaecologist. For these analyses,patient groups were split in a short and long diagnostic delay group, which was defined as ≤ 1 or >1 year.
Ethical Approval
Study design was approved by the local ethics committee. An information letter about the study was sent to the participants at least 1 week before
26 | Chapter 2