Page 93 - Diagnostic delay of endometriosis

care performance was assessed by the organisation of endometriosis care and implementation of the ESHRE guideline ‘Management of women with endometriosis’ (Dunselman et al., 2014). Organisational aspects included the number of newly diagnosed patients per year, whether these patients are seen by all gynaecologists or gynaecologists with a sub-specialisation, the presence of a multi-disciplinary team and the diagnostic and therapeutic options in the respondents’ hospital. The implementation of the ESHRE guideline was assessed by asking the gynaecologists about their familiarity and agreement with and practical implementation of the key recommendations in this guideline.15 These 17 key recommendations reflected a representative selection of the complete 83 item guideline as indicated by a panel of patients and medical professionals, and covers all aspects of endometriosis care. This included recommendations about diagnosis (n=4), treatment of endometriosis-associated pain (n=6), treatment of endometriosis-associated infertility (n=4) and the three miscellaneous topics prevention, menopause and cancer risk (n=1 for each topic). The term “diagnosis” was not specified in the questionnaire, which means that a suspicion based on physical examination and/or imaging techniques like ultrasonography or MRI sufficed, rather than confirmed by laparoscopy.
Agreement and adherence were assessed using a 5 (for agreement) and 6 (for adherence) point Likert scale. The answers “totally agree” and “agree” were scored as agrees with, and the answers “always” and “mostly” were scored as adheres to the recommendation. The questionnaire did not include validated instruments because no comparable studies were undertaken previously.
Analysis
Data were analysed using the Statistical Package for the Social Science (IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY). Answers to the open questions were categorised by MA and AN according to whether they related to the patient, GP or gynaecologist. Similar answers were grouped and labelled with an appropriate caption. For these questions more than one answer could be given, therefore the total number of answers was not always equal to the total number of respondents to the questions.
Ethical approval
The study protocol was evaluated by the Radboud University Medical Centre research ethics committee and is considered exempt from institutional review board approval (Reference number 2016-2629, dated June 22, 2016 ).
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