Primary care clinicians' perspectives on interacting with patients with gynaecological conditions: a systematic review

BACKGROUND

Studies have found that women with gynaecological conditions and symptoms do not feel listened to by primary care clinicians (PCCs). Less understood is whether PCCs perceive that there are challenges around listening to and interacting with this patient group.

AIM

To understand PCCs' perspectives on the challenges of listening to and interacting with women patients with gynaecological conditions and symptoms.

DESIGN & SETTING

Systematic review of English-language studies.

METHOD

We searched ASSIA (Applied Social Sciences Index and Abstracts), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Embase, HMIC (Healthcare Management Information Consortium), and MEDLINE from inception to July 2023. We also conducted forward and backward citation searches of included studies. Identified records were screened independently by two reviewers. Data extraction was undertaken by one reviewer and checked by a second. Quality appraisal used the Wallace checklist. 'Best-fit' framework synthesis was used to synthesise findings around themes that explored the challenges of patient-clinician interaction.

RESULTS

We identified 25 relevant articles. Perceived challenges associated with listening to and interacting with patients with gynaecological conditions and symptoms were identified at four 'levels': individual clinician level factors; structural and organisational factors; community and external factors; and factors related to gynaecological conditions. Interpretive analysis identified specific challenges relating to sociocultural factors affecting the consultation experience; the need for further education, training, or guidance for clinicians; factors affecting referral decisions; and factors related to service structure and organisation.

CONCLUSION

PCCs acknowledge that empathy, respect, and attentive listening are important when interacting with women patients with gynaecological conditions and symptoms. However, these ideals are impeded by several factors.

That one doctor. . . Qualitative thematic analysis of 49 women’s written accounts of their endometriosis diagnosis

Introduction:

One in nine women experience endometriosis, a common gynaecological disease, yet time to diagnosis averages 7 years. People are sharing their endometriosis experiences online. This research’s aim was to expose and synthesise the collective themes of diagnostic experience.

Method:

A qualitative thematic analysis of publicly accessible online autobiographical accounts of women and their endometriosis diagnosis. Themes were coded within NVIVO and thematic maps and tables created. Eighty-nine original accounts were identified, 26 were excluded. Saturation point was 49.

Results:

Women communicated long, painful and emotional journeys to diagnosis. Forty women experienced endometriosis symptoms before the age of 20, 33 before 15 years. Despite repeated GP presentation, 36 women had never heard of endometriosis before diagnosis. Women highlighted the positive impact of ‘that one doctor’ who said the word ‘endometriosis’ who listened, believed, investigated and provided prompt referral to specialists. Diagnosis gave relief and answers to the long journey, provided women a sense of community, hope and personal visibility after feeling alone. While this common disease is undiagnosed women suffer.

Conclusion:

‘That one doctor’ can transform a patient’s experience and create a positive diagnosis pathway towards endometriosis. The doctor patient alliance is vital for prompt diagnosis. Symptom dismissal with long diagnosis delays are having negative, physical and psychological consequences for women. Early detection, GP education and community awareness campaigns are imperative to reduce further delayed diagnosis and long-term negative impacts of undiagnosed endometriosis.

Pathophysiological Basis of Endometriosis-Linked Stress Associated with Pain and Infertility: A Conceptual Review

Women with endometriosis are often under stress due to the associated pain, infertility, inflammation-related and other comorbidities including cancer. Additionally, these women are also under stress due to taboos, myths, inter-personal troubles surrounding infertility and pain of the disease as well as due to frequent incidences of missed diagnosis and treatment recurrence. Often these women suffer from frustration and loss of valuable time in the prime phase of life. All these complexities integral to endometriosis posit a hyperstructure of integrative stress physiology with overt differentials in effective allostatic state in women with disease compared with disease-free women. In the present review, we aim to critically examine various aspects of pathophysiological basis of stress surrounding endometriosis with special emphasis on pain and subfertility that are known to affect the overall health and quality of life of women with the disease and promising pathophysiological basis for its effective management.