Research

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

Simon Briscoe, Jo Thompson Coon, G J Melendez-Torres, Rebecca Abbott, Liz Shaw, Michael Nunns and Ruth Garside
BJGP Open 2024; 8 (1): BJGPO.2023.0133. DOI: https://doi.org/10.3399/BJGPO.2023.0133

Abstract

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.

How this fits in

A substantial evidence base shows that women do not feel listened to by primary care clinicians (PCCs) when discussing their health concerns, particularly with respect to gynaecological conditions and symptoms. This is the first systematic review to address the challenges that PCCs report when listening to and interacting with women patients with gynaecological conditions and symptoms. The findings suggest that PCCs' interactions with women patients are impeded by their own limitations of knowledge and understanding, the structure and organisation of healthcare services, and the broader socio-cultural context. It is important to address these issues to support PCCs to provide appropriate treatment and support for women patients with gynaecological conditions and symptoms.

Introduction

The Women’s Health Strategy for England (WHSE) has identified several priority areas where women’s health care needs improvement, including gynaecological conditions, fertility and pregnancy, mental health and wellbeing, cancer, healthy ageing, and long-term conditions.1 Of these, gynaecological conditions were the most frequently mentioned health condition by women responders to a survey undertaken to inform the WHSE on priorities for women’s health care (63% of responders).1 Key concerns included not feeling listened to by PCCs and length of time to diagnosis, both of which are commonly reported elsewhere in studies of women’s perspectives of gynaecological health care.2–6

Delays to accessing treatment and support for gynaecological conditions and symptoms can lead to both physical and mental ill-health.7–11 Policymakers and healthcare providers recognise the profound effects that this has on women’s health and wellbeing.1,12,13 The WHSE sets out measures to improve treatment and support for gynaecological conditions as a matter of high priority.3 What is less well-known is whether PCCs perceive that there are challenges around interacting with patients with gynaecological conditions and symptoms. However, there is an emerging body of qualitative research that explores the challenges of diagnosis and management for this patient group, within which data on listening to and interacting with patients are reported.14–18 The aim of this study was to understand PCCs’ perspectives on the challenges of listening to and interacting with women patients with gynaecological conditions and symptoms. The review was commissioned by the UK National Institute for Health Research (NIHR) Policy Research Programme to inform the WHSE.1,19

Method

The method used for this systematic review followed established guidance.20,21 The protocol was registered on the Open Science Framework on 11 October 2021 (https://osf.io/2dw8n/).22 Reporting follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.23 Although in our protocol we initially set out to conduct a scoping review, we extended our analysis to a 'best-fit' framework synthesis to provide a richer analysis of the findings.20

Study identification

We searched CINAHL (Cumulative Index to Nursing and Allied Health Literature), Embase, HMIC (Healthcare Management Information Consortium), MEDLINE, and ASSIA (Applied Social Sciences Index and Abstracts). We also conducted forward and backward citation searches of included studies. The bibliographic database search strategies are reproduced in Supplementary Box S1. Titles and abstracts were independently double-screened using inclusion criteria described in Box 1. Although we included studies if the participant population consisted of both PCCs and secondary care clinicians, we did not include data relating to solely secondary care clinicians from within these studies. Disagreements were resolved through discussion with a third research team member. Full texts were screened in the same way.

Box 1

Inclusion criteria

Population: Primary care clinicians, including (but not limited to) GPs or family doctors, nurse practitioners, and community pharmacists.

Phenomenon of interest: Interaction with patients with gynaecological conditions, including (but not limited to) endometriosis, menopause,

 menstrual disorders, polycystic ovary syndrome, or symptoms suggestive of these conditions.

Context: Primary care in World Bank high-income countries were included.66

Study design: Recognised qualitative methods including (but not limited to) thematic analysis, framework analysis, grounded theory,

 phenomenology. Surveys were excluded.

Other: Only English-language studies were included.

Data extraction and quality appraisal

Data extraction included key study characteristics and identified themes. Data extraction and quality appraisal (using the Wallace checklist) was carried out by one reviewer and checked by a second.24

Synthesis

We used 'best-fit' framework synthesis to synthesise the findings.25 This involved a two-stage process: first, the creation of a list of themes and sub-themes based on a pre-existing framework; second, an interpretive analysis in which the relationships between the themes and sub-themes are established and elaborated.25 We selected Dixon et al as containing the most well-developed framework among the included articles.26 Dixon et al explored PCCs’ perspectives on diagnosing and managing endometriosis.26 The four ‘level’ thematic framework presented in Dixon et al is shown in Table 1. (Additional sub-themes were presented underneath these themes.) Findings from included articles were coded against this framework, adapting and adding new themes as necessary.25 Coding was undertaken by one reviewer and checked by a second. Themes and sub-themes were tabulated and described narratively. The interpretative analysis sought to draw out how PCCs’ perspectives on listening to and interacting with women patients (as described in the themes and sub-themes) could be understood in terms of challenges to listening to and interacting with this patient group.

View this table:
Table 1. Four level thematic framework

Results

Searches were conducted on 1 November 2021 and updated 3 July 2023 (see Supplementary Table S1). The screening process is depicted in Figure 1. The full list of studies excluded at full text is presented in Supplementary Table S2.

Figure 1.
Figure 1. PRISMA flow diagram

Characteristics of included studies

Twenty-five articles published 1998–2023 were included14–18,26–45 (see Table 2 and Supplementary Table S3). Four studies reported that a proportion of participants had a special interest in gynaecology, which in some studies was achieved through purposive sampling.17,29,41,43 Other studies used purposive sampling to recruit participants who are routinely exposed to populations or diseases of interest.30–32,35,37,40 This sometimes meant that more female than male participants were included.30,37

View this table:
Table 2. Study characteristics

Quality appraisal

Overall, the articles were assessed as good quality (see Supplementary Table S4).

Identified themes

PCCs’ perspectives on listening to and interacting with patients with gynaecological conditions or symptoms are described thematically within an adapted version of the four ‘level’ framework in Dixon et al in Supplementary Table S5.26 In addition, Supplementary Table S6 presents sub-themes that related to single gynaecological conditions only (organised separately under themes 5–10). To illustrate the findings of this stage of the analysis within the main text of this study, an abridged version of Supplementary Table S5 is presented in Table 3 showing the three sub-themes per theme with the most supporting studies.

View this table:
Table 3. Themes and sub-themes with most supporting studies per theme (see Table S5 for full list of sub-themes)

Interpretive analysis

Numbers in parentheses in this section refer to sub-themes in Supplementary Tables S5 and S6.

The identified themes and sub-themes suggest that clinicians recognise the need to treat women with empathy and respect (1.13), and acknowledge the psychosocial effects of gynaecological conditions and symptoms (1.14). However, given the findings of previous research, these perspectives have not translated into women feeling listened to. This section seeks to interpret PCCs’ perspectives on listening to and interacting with women patients in terms of challenges. To this end, we developed four interpretive themes related to the contexts in which primary care consultations take place:

  • sociocultural factors affecting the consultation experience;

  • the need for further education, training, or guidance for clinicians;

  • factors affecting the decision to refer women, including obtaining a definitive diagnosis;

  • factors related to service structure and organisations.

Theme 1: Sociocultural factors affecting the consultation experience

PCCs perceived that there remains stigma and embarrassment about gynaecological symptoms when discussing health concerns with patients, particularly among some minority ethnic groups (3.4). Furthermore, some clinicians perceived that patients considered that symptoms were part of normal life, which again was noted as prevalent within some minority ethnic groups (3.3). PCCs worried that these factors could lead to delays in women seeking appropriate care, or difficulties describing the experienced problem. However, researchers suggested in the analysis of their findings that clinicians might stereotype how minority ethnic groups view medical conditions rather than engage with individual patients (3.1).

There were differences in how male and female primary care doctors interact with women. With respect to menorrhagia, some male doctors reported relying solely on patients’ experience, feeling ill-equipped to do anything else (8.1). In contrast, female doctors indicated that they were more confident in combining in-depth exploration of patients’ experiences of menstrual bleeding with clinical judgement about the abnormality of the symptoms (8.1). More generally, some PCCs, who were often male, unhelpfully expected patients to comply rather than engage with care, viewing them as ‘good’ or ‘bad’ depending on how well they followed advice (1.16).

While some PCCs preferred patients who came to consultations with a clear idea of what they want (1.1), others thought information gleaned online might be inaccurate, leading to beliefs that were difficult to challenge (3.5). Accurate sources of online information were considered necessary to help patients understand their symptoms and for PCCs to be able to direct patients (3.5). Sometimes lifestyle and psychological factors, such as obesity, were considered as potential causes of symptoms that needed to be addressed before the patient would see an improvement in health (4.3). However, PCCs also felt that patients with polycystic ovary syndrome (PCOS) were reluctant to accept that there were no easy solutions (6.1) and considered that patients with chronic pelvic pain would disengage with primary care if they felt that they were not receiving appropriate treatment (9.2).

Theme 2: Need for further education, training, or guidance for clinicians

PCCs sometimes lacked sufficient knowledge of gynaecological conditions (1.6) owing to limited education (2.1) and guidelines (4.2), or infrequent exposure to these conditions (1.5) (especially among male clinicians). Understanding the difference between normality and pathology was considered an area that needed improvement in guidance across multiple conditions, including endometriosis, menopause, and menorrhagia (4.2). For example, understanding the difference between dysmenorrhoea and symptoms of endometriosis was considered challenging (4.1) and not clearly defined in guidance (4.2). Conversely, it was deemed unrealistic to become familiar with the extent of guidance across all potential health conditions that women experience (6.2). The extent of guidance combined with its perceived shortcomings meant that navigating and implementing guidance was challenging.

PCCs also reported struggling to find solutions for patients dissatisfied with care, particularly patients with long-term conditions (4.6). Chronic pelvic pain symptoms were often long-term and had no clear biomedical explanation, which was noted by GPs as particularly challenging for practice nurses (9.4). In particular, it was observed by GPs that practice nurses mainly carry out tests such as swabs, and have more limited skills for dealing with patients who may be somatising. However, despite the challenges entailed, practice nurses considered they could play a more significant role than they currently do with this patient group as they are often the first point of contact (9.4).

Theme 3: Diagnosis and decisions to refer women

Decisions about when to refer presented challenges for PCCs both from the perspective of making an appropriate judgement, and managing patient expectations of what constitutes a satisfactory outcome for consultation. It was noted that many gynaecological conditions are difficult to definitively diagnose, and some diagnoses require tests only obtainable through referral (4.1). However, referrals were not always made, even if there were symptoms that could justifiably lead to a referral. Sometimes PCCs did not refer because of concerns about potential adverse effects of invasive diagnostic tests, which meant they only referred if they considered there was a high probability of pathology (1.3). For example, younger women with symptoms of endometriosis were sometimes not referred owing to similarities with normal period pain (1.3). Overall, younger women were seen as less likely to have serious pathology and were less likely to be referred (1.16).

Some PCCs did not think a diagnosis was necessary if the symptoms could be adequately controlled in primary care (1.7) or would not affect treatment (1.12). For example, PCCs reported that patients who had been referred were sometimes told to focus on symptom control rather than investigation, which is something that they could do themselves (1.12). There was also reluctance to give patients a ‘label’ too early, particularly if this could cause patient anxiety (1.8) and concern to avoid over- or mis-diagnosis, which could lead to failure to treat the actual problem (4.5). Strategies for deciding when to refer included following a ‘diagnostic hierarchy’, which excluded red flags (such as cancer) after which PCCs had a reduced sense of urgency to investigate other conditions (4.4).

Perceived pressures on the healthcare system in secondary care might also influence decisions to refer (2.4). However, women who did not have English as a first language, those not wanting to be examined by a male clinician, or where infertility was a concern, might be more likely to be referred (3.2). More engaged and proactive women were also thought more likely to get referred (1.1).

Theme 4: Factors related to service structure and organisations

Challenges for clinician–patient interaction were also apparent in the structure and organisation of healthcare services. These included high GP workload and limited consultation time, potentially having a detrimental effect on quality of care (2.7). A lack of continuity of care was also perceived as a challenge, particularly where the need to build rapport with patients was seen as critical to effective communication and understanding (2.6).

Discussion

Summary

Our findings show that PCCs perceive that attentive listening is important when discussing gynaecological conditions and symptoms with patients. However, our findings also show that sociocultural factors can make it challenging to discuss symptoms with some patient groups, and can create different understandings of what constitutes pathology. Furthermore, gaps in understanding are not always covered in guidance, and factors influencing the decision to refer or diagnose gynaecological conditions can lead to a mismatch of expectations between PCCs and women patients. Structural issues present challenges for building rapport with patients.

Strengths and limitations

This review includes evidence on clinician–patient interaction relating to a variety of gynaecological conditions and symptoms. However, although we were able to identify data on listening to and interacting with women patients, in most studies data were inferred from wider discussion of the diagnosis and management of gynaecological conditions. Furthermore, differences in participant recruitment approaches in the included studies may have led to different perspectives being reported (for example, specialist versus non-specialist participants; male versus female participants). Sometimes this is drawn out in the findings of this review (for example, differences in the perspectives of male and female clinicians) but there is scope for more nuance in considering the differences between specialist and non-specialist PCCs.

Comparison with existing literature

Several systematic reviews to date focus on patients’ experiences of interacting with clinicians with respect to gynaecological conditions, including PCCs.46–53 These reviews draw attention to women not feeling listened to in consultation settings. However, to the best of our knowledge, ours is the first systematic review to address the challenges that PCCs’ report when listening to and interacting with this patient group. Similar findings about women’s experiences of health care more broadly have also been reported; for example, there is evidence that women experiencing chronic pain feel dismissed by clinicians.54–56 Furthermore, several studies show that men and women presenting with the same or similar symptoms are treated differently, with women more frequently receiving misdiagnosis or mismanagement of symptoms.57–61 This suggests that negative experiences of care experienced by women with gynaecological conditions or symptoms are part of a wider gender-related problem. Nonetheless, our review reveals specific challenges around listening to and interacting with this patient group.

Implications for research and practice

The complexity of the different factors that contribute to the challenges that PCCs experience in this area make it unlikely that there are simple solutions. Training and guidance are likely to be important in improving women patients’ experiences in primary care, and should address the importance of empathetic, respectful, and attentive communication, as well as the challenges of diagnosing and managing gynaecological conditions and symptoms. Studies show that improved listening and communication can improve trust in the clinician–patient relationship.62,63 However, our findings show there are also structural and organisational issues that need addressing. One way of achieving longer consultation times may be to more fully integrate a wider variety of healthcare professionals into routine consultation work as proposed in the UK NHS Five Year Forward View.64 Furthermore, any proposed changes to improving the timeliness and accuracy of diagnoses of gynaecological conditions and symptoms should take into account the view that diagnosis is not always the best outcome, even if symptoms are present.65

Sociocultural issues are difficult to address, particularly perceptions in the wider society, which are largely outside of clinicians’ and policymakers’ control. In particular, our findings show that patients in minority ethnic groups pose specific sociocultural challenges.15,31 More research in this area would be valuable. Calls have been made to implement public awareness campaigns that challenge the stigma of gynaecological conditions, and enhance the visibility of conversations about them, which we consider an important part of the solution.9,11 Women patients’ widely held preference to see female PCCs, however, may mean that although compulsory training on women’s health for all PCCs might improve the basic level of knowledge and awareness, male clinicians with less exposure to gynaecological conditions will still likely provide a different standard of care to female clinicians.1

Finally, further primary research is required that explicitly sets out to investigate the perspectives of PCCs on listening to and interacting with women patients.1

Notes

Funding

This study is funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme (NIHR200695 - Evidence review facility to support national policy development and evaluation). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Jo Thompson Coon and Rebecca Abbott are also supported by the NIHR Applied Research Collaboration South West Peninsula.

Ethical approval

Not applicable.

Provenance

Freely submitted; externally peer reviewed.

Data

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Acknowledgements

We acknowledge the Women’s Health Strategy team’s contribution to developing the research question and the inclusion and exclusion criteria. We also acknowledge the input of four UK-based primary care doctors on sense checking the coding framework.

Competing interests

The authors declare that no competing interests exist.

  • Received July 17, 2023.
  • Revision received September 28, 2023.
  • Accepted November 10, 2023.

This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)

References

  1. 1.↵
    1. Department of Health & Social Care
    (2022) Women’s Health Strategy for England, accessed. https://www.gov.uk/government/publications/womens-health-strategy-for-england/womens-health-strategy-for-england. 9 Jan 2024.
  2. 2.↵
    1. All Party Parliamentary Group on Endometriosis
    (2020) Endometriosis in the UK: time for change. accessed. https://www.endometriosis-uk.org/sites/default/files/files/Endometriosis%20APPG%20Report%20Oct%202020.pdf. 9 Jan 2024.
  3. 3.↵
    1. Connolly A,
    2. Regan L,
    3. Menstrual Health Coalition
    (2020) Heavy menstrual bleeding — breaking silence and stigma. accessed. https://www.menstrualhealthcoalition.com/hmbreport. 9 Jan 2024.
  4. 4.
    1. Gibson-Helm M,
    2. Teede H,
    3. Dunaif A,
    4. Dokras A
    (2017) Delayed diagnosis and a lack of information associated with dissatisfaction in women with polycystic ovary syndrome. J Clin Endocrinol Metab 102 (2):604–612, doi:10.1210/jc.2016-2963, pmid:27906550.
    OpenUrlCrossRefPubMed
  5. 5.
    1. Mumsnet.com
    (2021) Women are struggling to get appropriate help from GPs for perimenopause and menopause symptoms, accessed. https://www.mumsnet.com/articles/gps-and-menopause-survey. 9 Jan 2024.
  6. 6.↵
    1. Osborn E,
    2. Wittkowski A,
    3. Brooks J,
    4. et al.
    (2020) Women’s experiences of receiving a diagnosis of premenstrual dysphoric disorder: a qualitative investigation. BMC Womens Health 20 (1), doi:10.1186/s12905-020-01100-8, pmid:33115437. 242.
    OpenUrlCrossRefPubMed
  7. 7.↵
    1. de Salis I,
    2. Owen-Smith A,
    3. Donovan JL,
    4. Lawlor DA
    (2018) Experiencing menopause in the UK: the interrelated narratives of normality, distress, and transformation. J Women Aging 30 (6):520–540, doi:10.1080/08952841.2018.1396783, pmid:29095126.
    OpenUrlCrossRefPubMed
  8. 8.
    1. Hennegan J,
    2. Shannon AK,
    3. Rubli J,
    4. et al.
    (2019) Women’s and girls' experiences of menstruation in low- and middle-income countries: a systematic review and qualitative metasynthesis. PLoS Med 16 (5), doi:10.1371/journal.pmed.1002803, pmid:31095568. e1002803.
    OpenUrlCrossRefPubMed
  9. 9.↵
    1. Bobel C,
    2. Winkler IT,
    3. Fahs B,
    4. et al.
    1. Johnston-Robledo I,
    2. Chrisler JC
    (2020) in The Palgrave Handbook of Critical Menstruation Studies, eds Bobel C, Winkler IT, Fahs B, et al. (Palgrave Macmillan, Gateway East, Singapore) In, pp 181–199, doi:10.1007/978-981-15-0614-7. The menstrual mark: menstruation as social stigma.
    OpenUrlCrossRef
  10. 10.
    1. Nosek M,
    2. Kennedy HP,
    3. Gudmundsdottir M
    (2008) Stigma, and shame: distress during the menopause transition. J Midwifery Womens Health 53 (5):482–482, doi:10.1016/j.jmwh.2008.05.017.
    OpenUrlCrossRef
  11. 11.↵
    1. Sims OT,
    2. Gupta J,
    3. Missmer SA,
    4. Aninye IO
    (2021) Stigma and endometriosis: a brief overview and recommendations to improve psychosocial well-being and diagnostic delay. Int J Environ Res Public Health 18 (15):15, doi:10.3390/ijerph18158210, pmid:34360501. 8210.
    OpenUrlCrossRefPubMed
  12. 12.↵
    1. National Institute for Health and Care Excellence
    (2017) Endometriosis: diagnosis and mangement. NICE guideline [NG73]. accessed. https://www.nice.org.uk/guidance/ng73. 9 Jan 2024.
  13. 13.↵
    1. Royal College of Obstetricians & Gynaecologists
    (2019) Better for women: improving the health and wellbeing of girls and women, accessed. https://www.rcog.org.uk/about-us/campaigning-and-opinions/better-for-women. 9 Jan 2024.
  14. 14.↵
    1. Davis SR,
    2. Herbert D,
    3. Reading M,
    4. Bell RJ
    (2021) Health-care providers' views of menopause and its management: a qualitative study. Climacteric 24 (6):612–617, doi:10.1080/13697137.2021.1936486, pmid:34240683.
    OpenUrlCrossRefPubMed
  15. 15.↵
    1. MacLellan J,
    2. Dixon S,
    3. Bi S,
    4. et al.
    (2023) Perimenopause and/or menopause help-seeking among women from ethnic minorities: a qualitative study of primary care practitioners' experiences. Br J Gen Pract 73 (732):e511–e518, doi:10.3399/BJGP.2022.0569, pmid:37130614.
    OpenUrlAbstract/FREE Full Text
  16. 16.
    1. Rowe HJ,
    2. Hammarberg K,
    3. Dwyer S,
    4. et al.
    (2021) Improving clinical care for women with endometriosis: qualitative analysis of women’s and health professionals' views. J Psychosom Obstet Gynaecol 42 (3):174–180, doi:10.1080/0167482X.2019.1678022, pmid:31691598.
    OpenUrlCrossRefPubMed
  17. 17.↵
    1. van der Zanden M,
    2. Teunissen DAM,
    3. van der Woord IW,
    4. et al.
    (2020) Barriers and facilitators to the timely diagnosis of endometriosis in primary care in the Netherlands. Fam Pract 37 (1):131–136, doi:10.1093/fampra/cmz041, pmid:31414120.
    OpenUrlCrossRefPubMed
  18. 18.↵
    1. Young K,
    2. Fisher J,
    3. Kirkman M
    (2017) Clinicians' perceptions of women’s experiences of endometriosis and of psychosocial care for endometriosis. Aust N Z J Obstet Gynaecol 57 (1):87–92, doi:10.1111/ajo.12571, pmid:28251627.
    OpenUrlCrossRefPubMed
  19. 19.↵
    1. Department of Health & Social Care
    (2021) Our vision for the Women’s Health Strategy for England, accessed. https://www.gov.uk/government/publications/our-vision-for-the-womens-health-strategy-for-england. 9 Jan 2024.
  20. 20.↵
    1. Carroll C,
    2. Booth A,
    3. Cooper K
    (2011) A worked example of "best fit" framework synthesis: a systematic review of views concerning the taking of some potential chemopreventive agents. BMC Med Res Methodol 11 (1), doi:10.1186/1471-2288-11-29, pmid:21410933. 29.
    OpenUrlCrossRefPubMed
  21. 21.↵
    1. Higgins J,
    2. Thomas J,
    3. Chandler J,
    4. et al.
    1. Noyes J,
    2. Booth A,
    3. Cargo M,
    4. et al.
    (2022) in Cochrane Handbook for Systematic Reviews of Interventions version 6.3, eds Higgins J, Thomas J, Chandler J, et al. (Cochrane), In. Chapter 21: Qualitative evidence synthesis. https://training.cochrane.org/handbook.
  22. 22.↵
    1. Briscoe S,
    2. Shaw L,
    3. Nunns M,
    4. et al.
    (2021) Primary care clinicians’ perspectives on interacting with patients with gynaecological conditions or symptoms suggestive of gynaecological conditions: protocol for a scoping review, accessed. https://osf.io/2dw8n. 9 Jan 2024.
  23. 23.↵
    1. Page MJ,
    2. McKenzie JE,
    3. Bossuyt PM,
    4. et al.
    (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372 doi:10.1136/bmj.n71, pmid:33782057. n71.
    OpenUrlFREE Full Text
  24. 24.↵
    1. Wallace A,
    2. Baldwin S,
    3. Croucher K,
    4. Quilgars D
    (2004) Meeting the challenge: developing systematic reviewing in social policy. Policy & Politics 32 (4):455–470, doi:10.1332/0305573042009444.
    OpenUrlCrossRef
  25. 25.↵
    1. Carroll C,
    2. Booth A,
    3. Leaviss J,
    4. Rick J
    (2013) "Best fit" framework synthesis: refining the method. BMC Med Res Methodol 13 doi:10.1186/1471-2288-13-37, pmid:23497061. 37.
    OpenUrlCrossRefPubMed
  26. 26.↵
    1. Dixon S,
    2. McNiven A,
    3. Talbot A,
    4. Hinton L
    (2021) Navigating possible endometriosis in primary care: a qualitative study of GP perspectives. Br J Gen Pract 71 (710):e668–e676, doi:10.3399/BJGP.2021.0030, pmid:33950856.
    OpenUrlAbstract/FREE Full Text
  27. 27.
    1. Arasu A,
    2. Moran LJ,
    3. Robinson T,
    4. et al.
    (2019) Barriers and facilitators to weight and lifestyle management in women with polycystic ovary syndrome: general practitioners' perspectives. Nutrients 11 (5), doi:10.3390/nu11051024, pmid:31067757. 1024.
    OpenUrlCrossRefPubMed
  28. 28.
    1. Berterö C,
    2. Alehagen S,
    3. Grundström H
    (2019) Striving for a biopsychosocial approach: a secondary analysis of mutual components during healthcare encounters between women with endometriosis and physicians. J Endometr Pelvic Pain Disord 11 (3):146–151, doi:10.1177/2284026519865396.
    OpenUrlCrossRef
  29. 29.↵
    1. Bullo S,
    2. Weckesser A
    (2021) Addressing challenges in endometriosis pain communication between patients and doctors: the role of language. Front Glob Womens Health 2 doi:10.3389/fgwh.2021.764693, pmid:34870277. 764693.
    OpenUrlCrossRefPubMed
  30. 30.↵
    1. Bush TM,
    2. Bonomi AE,
    3. Nekhlyudov L,
    4. et al.
    (2007) How the Women’s Health Initiative (WHI) influenced physicians' practice and attitudes. J Gen Intern Med 22 (9):1311–1316, doi:10.1007/s11606-007-0296-z, pmid:17634782.
    OpenUrlCrossRefPubMed
  31. 31.↵
    1. Chapple A,
    2. Ling M,
    3. May C
    (1998) General practitioners' perceptions of the illness behaviour and health needs of South Asian women with menorrhagia. Ethn Health 3 (1–2):81–93, doi:10.1080/13557858.1998.9961851, pmid:9673466.
    OpenUrlCrossRefPubMed
  32. 32.↵
    1. Chappie A,
    2. May C,
    3. Ling M
    (2001) Is objective testing for menorrhagia in general practice practical?: results from a qualitative study. Eur J Gen Pract 7 (1):13–17, doi:10.3109/13814780109048778.
    OpenUrlCrossRef
  33. 33.
    1. Copp T,
    2. Muscat DM,
    3. Hersch J,
    4. et al.
    (2022) The challenges with managing polycystic ovary syndrome: a qualitative study of women’s and clinicians' experiences. Patient Educ Couns 105 (3):719–725, doi:10.1016/j.pec.2021.05.038, pmid:34099308. S0738-3991(21)00394-3.
    OpenUrlCrossRefPubMed
  34. 34.
    1. Copp T,
    2. Muscat DM,
    3. Hersch J,
    4. et al.
    (2020) Clinicians' perspectives on diagnosing polycystic ovary syndrome in Australia: a qualitative study. Hum Reprod 35 (3):660–668, doi:10.1093/humrep/deaa005, pmid:32101283.
    OpenUrlCrossRefPubMed
  35. 35.↵
    1. DePree B,
    2. Houghton K,
    3. DiBenedetti DB,
    4. et al.
    (2023) Practice patterns and perspectives regarding treatment for symptoms of menopause: qualitative interviews with US health care providers. Menopause 30 (2):128–135, doi:10.1097/GME.0000000000002096, pmid:36696636.
    OpenUrlCrossRefPubMed
  36. 36.
    1. Esposito N
    (2005) Agenda dissonance: immigrant Hispanic women’s and providers' assumptions and expectations for menopause healthcare. Clin Nurs Res 14 (1):32–56, doi:10.1177/1054773804270091, pmid:15604227.
    OpenUrlCrossRefPubMed
  37. 37.↵
    1. Fernandes A,
    2. Skotnes L-L,
    3. Major M,
    4. Falcão PF
    (2020) Clinicians' perceptions of Norwegian women’s experiences of infertility diseases. Int J Environ Res Public Health 17 (3), doi:10.3390/ijerph17030993, pmid:32033324. 993.
    OpenUrlCrossRefPubMed
  38. 38.
    1. Grundström H,
    2. Kjølhede P,
    3. Berterö C,
    4. Alehagen S
    (2016) "A challenge" — healthcare professionals' experiences when meeting women with symptoms that might indicate endometriosis. Sex Reprod Healthc 7 65–69, doi:10.1016/j.srhc.2015.11.003, pmid:26826048. S1877-5756(15)00085-3.
    OpenUrlCrossRefPubMed
  39. 39.
    1. Labots-Vogelesang MS,
    2. Teunissen DAM,
    3. Kranenburg V,
    4. Lagro-Janssen ALM
    (2021) Views of Dutch general practitioners about premenstrual symptoms: a qualitative interview study. Eur J Gen Pract 27 (1):19–26, doi:10.1080/13814788.2021.1889505, pmid:33729076.
    OpenUrlCrossRefPubMed
  40. 40.↵
    1. May C,
    2. Allison G,
    3. Chapple A,
    4. et al.
    (2004) Framing the doctor–patient relationship in chronic illness: a comparative study of general practitioners' accounts. Sociol Health Illn 26 (2):135–158, doi:10.1111/j.1467-9566.2004.00384.x, pmid:15027982.
    OpenUrlCrossRefPubMed
  41. 41.↵
    1. McGowan L,
    2. Escott D,
    3. Luker K,
    4. et al.
    (2010) Is chronic pelvic pain a comfortable diagnosis for primary care practitioners: a qualitative study. BMC Fam Pract 11 doi:10.1186/1471-2296-11-7, pmid:20105323. 7.
    OpenUrlCrossRefPubMed
  42. 42.
    1. Nekhlyudov L,
    2. Bush T,
    3. Bonomi AE,
    4. et al.
    (2009) Physicians' and women’s views on hormone therapy and breast cancer risk after the WHI: a qualitative study. Women Health 49 (4):280–293, doi:10.1080/03630240903158446, pmid:19753504.
    OpenUrlCrossRefPubMed
  43. 43.↵
    1. O’Flynn N,
    2. Britten N
    (2004) Diagnosing menstrual disorders: a qualitative study of the approach of primary care professionals. Br J Gen Pract 54 (502):353–358, pmid:15113518.
    OpenUrlAbstract/FREE Full Text
  44. 44.
    1. Selfe SA,
    2. Van Vugt M,
    3. Stones WR
    (1998) Chronic gynaecological pain: an exploration of medical attitudes. Pain 77 (2):215–225, doi:10.1016/S0304-3959(98)00104-3, pmid:9766840.
    OpenUrlCrossRefPubMed
  45. 45.↵
    1. Young K,
    2. Fisher J,
    3. Kirkman M
    (2019) "Do mad people get endo or does endo make you mad?”: Clinicians’ discursive constructions of medicine and women with endometriosis. Fem Psychol 29 (3):337–356, doi:10.1177/0959353518815704.
    OpenUrlCrossRef
  46. 46.↵
    1. Ghai V,
    2. Subramanian V,
    3. Jan H,
    4. et al.
    (2021) A meta-synthesis of qualitative literature on female chronic pelvic pain for the development of a core outcome set: a systematic review. Int Urogynecol J 32 (5):1187–1194, doi:10.1007/s00192-021-04713-1, pmid:33822256.
    OpenUrlCrossRefPubMed
  47. 47.
    1. Hoga L,
    2. Rodolpho J,
    3. Gonçalves B,
    4. Quirino B
    (2015) Women’s experience of menopause: a systematic review of qualitative evidence. JBI Database System Rev Implement Rep 13 (8):250–337, doi:10.11124/jbisrir-2015-1948, pmid:26455946.
    OpenUrlCrossRefPubMed
  48. 48.
    1. Lau GM,
    2. Elghobashy M,
    3. Thanki M,
    4. et al.
    (2022) A systematic review of lived experiences of people with polycystic ovary syndrome highlights the need for holistic care and co-creation of educational resources. Front Endocrinol (Lausanne) 13 doi:10.3389/fendo.2022.1064937, pmid:36531482. 1064937.
    OpenUrlCrossRefPubMed
  49. 49.
    1. Meads C,
    2. Hunt R,
    3. Martin A,
    4. Varney J
    (2019) A systematic review of sexual minority women’s experiences of health care in the UK. Int J Environ Res Public Health 16 (17):17, doi:10.3390/ijerph16173032, pmid:31438599. 3032.
    OpenUrlCrossRefPubMed
  50. 50.
    1. Pozzar RA,
    2. Berry DL
    (2023) Communicating is analogous to caring: a systematic review and thematic synthesis of the patient–clinician communication experiences of individuals with ovarian cancer. Palliat Support Care 21 (3):515–533, doi:10.1017/S1478951522000621, pmid:35582975.
    OpenUrlCrossRefPubMed
  51. 51.
    1. Stanzel DKA,
    2. Hammarberg DK,
    3. Fisher PJ
    (2021) Challenges in menopausal care of immigrant women. Maturitas 150 49–60, doi:10.1016/j.maturitas.2021.05.008, pmid:34112552. S0378-5122(21)00078-5.
    OpenUrlCrossRefPubMed
  52. 52.
    1. Stanzel KA,
    2. Hammarberg K,
    3. Fisher J
    (2018) Experiences of menopause, self-management strategies for menopausal symptoms and perceptions of health care among immigrant women: a systematic review. Climacteric 21 (2):101–110, doi:10.1080/13697137.2017.1421922, pmid:29345497.
    OpenUrlCrossRefPubMed
  53. 53.↵
    1. Young K,
    2. Fisher J,
    3. Kirkman M
    (2015) Women’s experiences of endometriosis: a systematic review and synthesis of qualitative research. J Fam Plann Reprod Health Care 41 (3):225–234, doi:10.1136/jfprhc-2013-100853, pmid:25183531.
    OpenUrlAbstract/FREE Full Text
  54. 54.↵
    1. Samulowitz A,
    2. Gremyr I,
    3. Eriksson E,
    4. Hensing G
    (2018) “Brave men" and "emotional women": a theory-guided literature review on gender bias in health care and gendered norms towards patients with chronic pain. Pain Res Manag 2018 doi:10.1155/2018/6358624, pmid:29682130. 6358624.
    OpenUrlCrossRefPubMed
  55. 55.
    1. Hintz EA
    (2023) "It’s all in your head": A meta-synthesis of qualitative research about disenfranchising talk experienced by female patients with chronic overlapping pain conditions. Health Commun 38 (11):2501–2515, doi:10.1080/10410236.2022.2081046, pmid:35694781.
    OpenUrlCrossRefPubMed
  56. 56.↵
    1. Igler EC,
    2. Defenderfer EK,
    3. Lang AC,
    4. et al.
    (2017) Gender differences in the experience of pain dismissal in adolescence. J Child Health Care 21 (4):381–391, doi:10.1177/1367493517727132, pmid:29110522.
    OpenUrlCrossRefPubMed
  57. 57.↵
    1. Banco D,
    2. Chang J,
    3. Talmor N,
    4. et al.
    (2022) Sex and race differences in the evaluation and treatment of young adults presenting to the emergency department with chest pain. J Am Heart Assoc 11 (10), doi:10.1161/JAHA.121.024199, pmid:35506534. e024199.
    OpenUrlCrossRefPubMed
  58. 58.
    1. Chen EH,
    2. Shofer FS,
    3. Dean AJ,
    4. et al.
    (2008) Gender disparity in analgesic treatment of emergency department patients with acute abdominal pain. Acad Emerg Med 15 (5):414–418, doi:10.1111/j.1553-2712.2008.00100.x, pmid:18439195.
    OpenUrlCrossRefPubMed
  59. 59.
    1. Kim I,
    2. Field TS,
    3. Wan D,
    4. et al.
    (2022) Sex and gender bias as a mechanistic determinant of cardiovascular disease outcomes. Can J Cardiol 38 (12):1865–1880, doi:10.1016/j.cjca.2022.09.009, pmid:36116747. S0828-282X(22)00858-3.
    OpenUrlCrossRefPubMed
  60. 60.
    1. Maserejian NN,
    2. Link CL,
    3. Lutfey KL,
    4. et al.
    (2009) Disparities in physicians' interpretations of heart disease symptoms by patient gender: results of a video vignette factorial experiment. J Womens Health (Larchmt) 18 (10):1661–1667, doi:10.1089/jwh.2008.1007, pmid:19785567.
    OpenUrlCrossRefPubMed
  61. 61.↵
    1. Newman-Toker DE,
    2. Moy E,
    3. Valente E,
    4. et al.
    (2014) Missed diagnosis of stroke in the emergency department: a cross-sectional analysis of a large population-based sample. Diagnosis (Berl) 1 (2):155–166, doi:10.1515/dx-2013-0038, pmid:28344918. /j/dx.2014.1.issue-2/dx-2013-0038/dx-2013-0038.xml.
    OpenUrlCrossRefPubMed
  62. 62.↵
    1. Jagosh J,
    2. Donald Boudreau J,
    3. Steinert Y,
    4. et al.
    (2011) The importance of physician listening from the patients' perspective: enhancing diagnosis, healing, and the doctor–patient relationship. Patient Educ Couns 85 (3):369–374, doi:10.1016/j.pec.2011.01.028, pmid:21334160.
    OpenUrlCrossRefPubMed
  63. 63.↵
    1. Rolfe A,
    2. Cash-Gibson L,
    3. Car J,
    4. et al.
    (2014) Interventions for improving patients' trust in doctors and groups of doctors. Cochrane Database Syst Rev 2014 (3), doi:10.1002/14651858.CD004134.pub3, pmid:24590693. CD004134.
    OpenUrlCrossRefPubMed
  64. 64.↵
    1. NHS England
    (2014) NHS Five Year Foward View, accessed. https://www.england.nhs.uk/publication/nhs-five-year-forward-view. 10 Jan 2024.
  65. 65.↵
    1. Irving G,
    2. Neves AL,
    3. Dambha-Miller H,
    4. et al.
    (2017) International variations in primary care physician consultation time: a systematic review of 67 countries. BMJ Open 7 (10), doi:10.1136/bmjopen-2017-017902, pmid:29118053. e017902.
    OpenUrlAbstract/FREE Full Text
  66. 66.↵
    1. The World Bank
    (2022) World Bank country and lending groups, accessed. https://datahelpdesk.worldbank.org/knowledgebase/articles/906519. 10 Jan 2024.
Back to top

In this issue

BJGP Open
Vol. 8, Issue 1
April 2024
Download PDF
Download PowerPoint
Email Article
Citation Tools
Primary care clinicians’ perspectives on interacting with patients with gynaecological conditions: a systematic review
Simon Briscoe, Jo Thompson Coon, G J Melendez-Torres, Rebecca Abbott, Liz Shaw, Michael Nunns, Ruth Garside
BJGP Open 2024; 8 (1): BJGPO.2023.0133. DOI: 10.3399/BJGPO.2023.0133
del.icio.us logo Twitter logo Facebook logo Mendeley logo

Jump to section

Keywords

Intended for Healthcare Professionals

 
 

British Journal of General Practice