Patients' Perspectives on How to Improve Endometriosis Care: A Large Qualitative Study Within the ComPaRe-Endometriosis e-Cohort

Background: Endometriosis is a chronic gynecological condition that affects about 10% of women of reproductive age. Despite its prevalence, diagnosis is often delayed, misdiagnosis is common, and treatment options are poor. This study aimed at capturing ideas to improve endometriosis care from the patients' perspectives. Materials and Methods: We analyzed cross-sectional data from 1,000 adult patients in ComPaRe-Endometriosis (a French prospective e-cohort focused on endometriosis) who answered to the open-ended question: "If you had a magic wand, what would you change about your health care?". The free-text responses were analyzed by qualitative thematic analysis using an inductive approach. Results: Patients had a mean age of 34.1 years (standard deviation = 8.1); 56% and 42% had stage IV disease or deep endometriosis, respectively. They elicited 2,487 ideas to improve the management of endometriosis, which were categorized into 61 areas of improvement, further grouped into 14 themes. The top five areas of improvement were mentioned by >10% of the patients and were to (1) train caregivers to develop their knowledge on the disease, (2) provide better management of daily pain and pain attacks, (3) take patient-reported symptoms seriously, (4) standardize diagnostic processes to improve early detection, and (5) have caregivers listen more to the patients. Conclusions: We identified 61 areas for improvement in endometriosis care. These results reflect patients' expectations in terms of management of their disease and will be useful to design a better global care for endometriosis from the patients' perspectives.

P–327 Patients’ perspectives on how to improve the management of endometriosis in France: The ComPaRe-Endometriosis cohort

Study question

How should endometriosis management be improved from the patient’s point of view?

Summary answer

One thousand endometriosis patients proposed 2,587 ideas to improve the management of endometriosis that reflect three main themes: diagnosis, care, and information on the disease.

What is known already

Endometriosis is a gynecologic condition affecting 10% of reproductive-age women. The disease causes severe pelvic pain and has a dramatic impact on women’s quality of life. A mean delay of 7 years was described between onset of symptoms and diagnosis. There is an urgent need to reduce this delay and to rethink endometriosis care in order to adopt a more comprehensive and patient-centered approach, as women are often dissatisfied with the care they receive.

Study design, size, duration

This study was carried out in a random sample of endometriosis patients participating in ComPaRe (Community of Patients for Research), a prospective e-cohort of adult chronic disease patients who will be followed-up for 10 years. Participants complete monthly online questionnaires about their life with their disease(s). Recruitment began in January 2017 and is still ongoing, with currently 44,000 participants, including 10,000 endometriosis patients in the ComPaRe-Endometriosis sub-cohort.

Participants/materials, setting, methods

We selected a random sample of 1,000 participants in ComPaRe-Endometriosis, forming 3 equal groups of age (<25, 25–45, >45 years old) and education (<12, 12–14, >14 years). We conducted a qualitative study to gather their ideas for improving the management of their disease. Participants were asked: “If you had a magic wand, what would you change in your health care?”. One interviewer and two patients independently extracted ideas from the open-ended responses using thematic analysis.

Main results and the role of chance

Patients proposed a total of 2,587 ideas to improve the management of endometriosis, which we classified in three main themes: diagnosis, care, and information on the disease. To improve diagnosis, women proposed 724 ideas classified into 11 areas of improvement, including training of health professionals, taking symptoms seriously, improving the diagnosis process, and recognition of the disease by clinicians. To improve care, patients gave 1,677 ideas classified into 71 areas of improvement. For example, they asked for a better pain management, more listening from caregivers, the reimbursement of care or medical treatments, help in accessing clinicians that are expert in endometriosis, and reduced waiting times for medical appointments and exams. Finally, to improve information on the disease, participants suggested 186 ideas classified into 5 areas of improvement, covering more explanation about the disease, public recognition of endometriosis and general awareness, and more research and more explanation of research results.

Limitations, reasons for caution

The results were reviewed by three people in order to reduce the margin of interpretation in the analysis of this open-ended question, but some subjectivity remains. Generalizability may be difficult because the results are linked to the specificities of the French model of care.

Wider implications of the findings: Through the many ideas proposed by patients, we identified a total of 87 areas for improvement in endometriosis diagnosis, care, and information. These results reflect patients’ expectations in terms of management of their disease and will be useful to design a better global care for endometriosis from the patients’ perspective.

Trial registration number

Not applicable