Diagnostic Delays in Endometriosis: Contributing Factors

Unraveling Diagnostic Delays in Endometriosis: A Global Review of Contributing Factors

Key Points

Importance:

• Diagnostic delays in endometriosis with an alarming average delay of 6.8 years highlights critical gaps in the healthcare system and negative impacts on the patient's quality of life.

Highlights:

• Diagnostic delays in endometriosis are well-documented but poorly understood in terms of their healthcare system origins. 
• Addressing social-ecological theoretical framework to analyze factors contributing to the delays is essential for improving patient outcomes and optimizing health system efficiency.

What's done here:

• Fryer et al penned this scoping review to summarize the literature on the diagnostic delay of endometriosis using the social-ecologic theoretical framework.
• Known databases searched from inception to September 2023, and related studies studies were examined.
• Out of 403 studies, 23 met the inclusion criteria, encompassing more than 9000 patients.
• Most frequently reported symptom, length, and reason for delay evaluated, and studies grouped studies based on themes to create a public policy perspective using the socio-ecological model.

Basic Outlines:

• The average diagnostic delay was changing between 1.5 years (in Australia) to 11.4 years (in USA), with an average of 6.8 years.
• In adults, the shortest reported delay was 1 year, and the longest delay was 27 years. This experience for adolescents was shortest in Brazil and Italy with 0.5 year while the longest delay was 35 years in Italy.
• The delay in diagnosis may be related to both patients and healthcare providers, in terms of a general lack of understanding and education about endometriosis.
• Reducing the delay of diagnosis includes education, awareness, multidisciplinary work, use of screening tools, presence of clinical guidelines, improving access to medical records, and use of reliable diagnostic indicators.
• Considering the impact on individuals and the health system, addressing diagnostic delay for endometriosis must remain a priority for researchers, health care providers and policy makers.

Lay Summary

While the delay in diagnosing endometriosis is well-documented, the reasons behind this delay and the specific gaps in the healthcare system remain poorly understood. Transvaginal ultrasound and magnetic resonance imaging are useful tools in detecting the condition, but laparoscopic surgery remains the 'gold standard' for a definitive diagnosis.

In their recent study published in Health Care for Women International, Fryer et al. from North Shields Council, Harrogate, UK, explored the reasons behind the clinical delay in diagnosing endometriosis. The study applied a socio-ecological model to address the multifaceted issues contributing to this delay. After a comprehensive literature search across four databases, and 403 articles were screened. Of these, 23 studies met the criteria for qualitative synthesis.

This scooping review revealed that the global diagnostic delay for endometriosis ranges widely, with an average delay of 6.8 years. The authors categorized the factors contributing to this delay into key themes including education, awareness, multidisciplinary collaboration, the use of screening tools, the presence of clinical guidelines, access to medical records and the use of reliable diagnostic indicators. Following this analysis, they discussed potential interventions to reduce delays across various points in the healthcare system. A schematic diagram was used to visually represent the socio-ecological model, showing how these six factors are interrelated in explaining diagnostic delays.

In their conclusion, the authors emphasized the value of identifying the "excess delay" in diagnosis, which could enable more accurate regional, national, and international comparisons. They also noted that the length of diagnostic delay has significant implications not only for the affected women but also for the broader healthcare system, influencing both costs and clinical outcomes.

Research Source: https://pubmed.ncbi.nlm.nih.gov/39418593/