| 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.