1. The role of pelvic examination in primary care in diagnosing gynaecological cancer
- Author
-
Williams, Pauline, Murchie, Peter, Cruickshank, Maggie, Bond, Christine M., and Burton, Christopher
- Subjects
Gynecology ,Pelvis ,Cancer ,Generative organs, Female - Abstract
Introduction: Pelvic examination (PE) is an intimate examination which is recommended by urgent suspected cancer referral guidelines for women with symptoms of a potential gynaecological cancer but may not always be undertaken. The aim of this project was to investigate the role of PE in primary care in diagnosing gynaecological cancer. Methods: A mixed methods approach was used to answer six research questions. Two systematic literature reviews answered RQs 1-4: 1) What factors influence patient and primary care delay in the diagnostic pathway of gynaecological cancer? 2) Is PE used by GPs to assess women with symptoms suggestive of a gynaecological cancer? 3) What is the quality of PE performed by GPs? and 4) What is the association between PE and referral outcomes? A data-linkage study explored RQ5: Is there an association between pre- referral PE and cancer stage at diagnosis? Qualitative enquiries with clinicians answered RQ6: What are the perceptions and experiences of GPs and secondary care specialists on the role of primary care based pelvic examination, and the barriers and facilitators to undertaking it? Results: Patient age and deprivation, symptom type and symptom knowledge influence diagnostic delay. Pre-referral PE was associated with early stage gynaecological cancer (adjusted OR 4.40; 95% CI 2.21-8.87). Presenting symptom was the most powerful predictor for pre-referral PE by a GP (adjusted OR 9.44; CI 4.71-18.91). Clinicians need capability, opportunity and motivation to perform PE. These three themes were influenced by perceived patient beliefs. Conclusions: Pre-referral PE increases the chance of early stage diagnosis but is often not undertaken. Study findings have identified GP barriers and facilitators to performing PE, but we still need to get patients' views. The aim will be to use this information to contribute to the development of a complex intervention to improve gynaecological cancer outcomes.
- Published
- 2021