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- Figure 1. PRISMA flow diagram
Tables
Theme Explanationa 1. Individual clinician level factors How decisions about patient care are informed by perspectives of PCCs on diagnosing and managing gynaecological conditions and symptoms in one-to-one consultation settings. 2. Structural and organisational factors How the design and management of primary care settings affects the care provided, and how wider issues in secondary care affect primary care. 3. Community and external factors How wider sociocultural issues and beliefs affect interactions between PCCs and patients. 4. Factors related to gynaecological conditions How factors related to gynaecological conditions affect interactions between PCCs and patients, specifically where these factors were identified across multiple gynaecological conditions. aWe have changed language for ‘endometriosis’ as presented in Dixon et al to more generically ‘gynaecological conditions’ for the purpose of the broader scope of the present study.26 PCC = primary care clinician.
Characteristic Data (number of studies with data, %) Type of primary care clinician Community gynaecologist (1, 4%); GP (20, 80%); internist or family practitioner (2, 8%); nurse (4, 16%); pharmacist (2, 8%) Condition Chronic pelvic pain (2, 8%); endometriosis (8, 32%); infertility disease (1, 4%); menopause (6, 24%); menorrhagia (3, 12%); menstrual disorders (1, 4%); PCOS (3, 12%); premenstrual symptoms (1, 4%) Country setting Australia (7, 28%); The Netherlands (2, 8%); Norway (1, 4%); Sweden (2, 8%); UK (9, 36%); US (4, 16%) PCOS = polycystic ovary syndrome.
- Table 3. Themes and sub-themes with most supporting studies per theme (see Table S5 for full list of sub-themes)
Themes Sub-themes(supporting studies, n) Descriptions and supporting quotations Individual clinician level factors 1.13a Treating women with empathy and respect (n = 10)14,16,26,28,34,38–41,44 PCCs recognised the importance of empathising with how women feel. Respecting patients meant discussing symptoms and conditions in an open manner that was not dismissive of women’s ability to understand potential diagnoses and management. 1.14 Understanding psychosocial impacts of gynaecological conditions (n = 13)14,16,18,26,28,31,34,35,37–41,44 PCCs recognised a need for an holistic approach to patient care, and showing an understanding of the psychological and social effects of a condition as well as the physiological effects. 1.15 Using women’s subjective awareness of what is normal and abnormal to inform decision making (n = 10)16,28,29,31,32,38,40,41,43,45 PCCs described how they take into account women’s perceptions of what is normal or abnormal pain or bleeding. Abnormal pain was characterised as enough difference to interfere with patients’ daily living.38 Structural and organisational factors 2.2 Limited education for primary care clinical team (n = 6)14,16,17,26,38,41 PCCs reported that they did not receive much training on women’s health issues during their professional education or ongoing training. Limited education was raised as an issue for menopause, chronic pelvic pain and endometriosis, as well as generally for women’s health issues. 2.5 Recognition of the importance of a multidisciplinary approach (n = 5)16,17,28,34,38 PCCs considered that a collaborative approach to working with other clinical specialists could improve the level of care that a patient receives. 2.7 Unmanageable primary care doctor workload (n = 7)14,15,18,26,27,32,36,44 PCCs perceived that high levels of GP workload sometimes prevented them from doing more than the minimum required for their patients. Community and external factors 3.3 Normalisation of symptoms in wider society and among clinicians (n = 6)15,16,26,31,35,36,38,45 PCCs perceived that symptoms of gynaecological conditions, including pain and heavy menstrual bleeding, are not always recognised by patients as outside of the normal range. 3.4 Stigma or embarrassment of menstrual conditions and symptoms among patients (n = 8)14,16,17,26,29,31,32,37 PCCs perceived that there is stigma and embarrassment about menstrual conditions and symptoms. This can include cultural stigma surrounding menstruation and embarrassment about visible signs of bleeding. 3.5 Web-based sources of accurate information are needed to correct misinformation (n = 6)15,16,18,26,28,33,34 PCCs noted that there was a preponderance of online misinformation about gynaecological conditions.18,34 PCCs would find it helpful to be able to signpost patients to reliable sources of online information.16,26 Factors related to gynaecological conditions 4.1 Gynaecological conditions can be difficult to definitively diagnose (n = 9)17,18,26,28,29,34,37,41,43 PCCs reported that some gynaecological conditions require multiple visits to see a clinician to assess the patients’ symptoms over time. 4.3 Medicalisation of social phenomena or not believing there to be a physical issue (n = 7)16,18,34,39,41,44,45 PCCs considered that symptoms associated with gynaecological conditions could arise owing to psychological issues rather than physical issues, in particular, symptoms of endometriosis and chronic pelvic pain.18,41,45 4.4 Need to follow a diagnostic hierarchy (n = 8)16,17,26,34,36,38,41,44 PCCs seek to exclude the most serious conditions before considering less serious or time-sensitive conditions. Once more serious conditions had been excluded, clinicians’ sense of urgency for a diagnosis was reduced if the symptoms were not severe. aSubtheme numbers are the same as in Supplementary Table S5. PCC = primary care clinician.
Supplementary Data
- SB_10.3399BJGPO.2023.0133_supp.pdf -
Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.
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Primary care clinicians’ perspectives on interacting with patients with gynaecological conditions: a systematic review
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