Patient and Practitioner: The Impact of Social Factors on Diagnostic Delay for Endometriosis

Abstract

Introduction:Endometriosis is a gynaecological disease with diverse symptoms that are often shared with other disorders and is characterized by long diagnostic delays. Delayed diagnosis prevents patients from receiving access to care and negatively impacts both physical and mental health. While technical limitations of the diagnostic procedure contribute to the delay, there is also significant delay in first seeking consultation as well as getting referred to specialized care that point to social differences rather than medical factors. This literature review aims to identify social determinants that contribute to these delays in endometriosis diagnosis. Methods: A literary search was conducted using PubMed, PsycInfo, and Web of Science. The search yielded a total of 549 articles. Of these, 22 articles were selected based on established search terms and criteria including that the articles had to present original data, be written in English, be published no earlier than 2012, and have full-text availability. Results: Factors contributing to diagnostic delay can be related to one of two groups: the patient and the practitioner Patient factors that increase delay include certain demographic characteristics, the extent of pain normalization, the stigma surrounding women's health, and the lack of self-advocacy. Practitioner factors that increase diagnostic delay include dismissive attitudes, the lack of knowledge and technical competence concerning endometriosis, and their relationship with patients as a position of authority. Discussion: Many identified factors share similar themes but are manifested differently amongst patients and practitioners, particularly those relating to the lack of familiarity with endometriosis and the normalization or dismissal of symptoms. Shared findings point to larger societal factors influencing both patients and practitioners. Conclusion:The findings of this review provide insight into social determinants that contribute to the long delays associated with endometriosis diagnosis. Future research should be aimed at establishing interventions for identified factors and also address larger shared social beliefs and misconceptions that maintain stigmas about women's health.