Page 81 - Diagnostic delay of endometriosis

other medical specialists to report on endometriosis as an incidental finding or secondary diagnosis, for instance when spots are visualized at laparoscopy for another indication or when diagnosed in the workup of infertility.
“I think it would help if we got a lot of correspondence letters from the fertility specialists in which endometriosis is mentioned as a secondary diagnosis. That would keep us alert about the condition.”[FG2, GP6, female]
The GPs experienced that other medical specialists like urologists, surgeons or gastro-enterologists also have a lack of knowledge about endometriosis. They suggested improving knowledge in these specialists, as well as collaboration between gynaecologists and other medical specialists.
Discussion
This study has yielded rich information about barriers and facilitators in general practice regarding the diagnostic process of endometriosis.
The most important finding is the fact that symptoms that may be characteristic for endometriosis, are not easily recognized. Moreover, GPs appear to have a low sense of urgency about confirming the diagnosis of endometriosis even if they consider it as a possible explanation for these symptoms. The GPs are rather reluctant in referring women to a gynaecologist for further diagnostics on endometriosis, especially if these women are of young age. These barriers to a timely referral and diagnosis possibly result from limitations in knowledge and awareness amongst GPs. Facilitating factors are infertility as reason for the consultation, patient engagement, and a recent serious case or training. The GPs stated that improvement in collaboration with gynaecologists is necessary. For example; in developing a joint national clinical guideline, improvement in correspondence letters and additional training for GPs. This may enhance awareness on endometriosis, including understanding of the importance of adequate treatment and when referral for advanced diagnostic testing or specialist treatment is required.
The importance of findings derived from qualitative research has been increasingly appreciated 11,14. However, careful consideration on study methodology is of great importance to secure study validity 13,15,16. To extract all relevant information in an objective manner, we conducted a data-based analysis style by two independent researchers, and all steps of data analysis
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