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Research

Women’s experiences of diagnosis and management of polycystic ovary syndrome: a mixed-methods study in general practice

Sarah C Hillman, Carol Bryce, Rachel Caleychetty and Jeremy Dale
British Journal of General Practice 2020; 70 (694): e322-e329. DOI: https://doi.org/10.3399/bjgp20X708881
Sarah C Hillman
National Institute for Health Research clinical lecturer in primary care;
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Carol Bryce
Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry.
Roles: Research fellow in primary care
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Rachel Caleychetty
Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry.
Roles: Assistant professor in primary care
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Jeremy Dale
Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry.
Roles: Professor of primary care
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  • Women’s experiences of diagnosis and management of polycystic ovary syndrome
    Darmeena Gopikrishna, Asha Kanwal and Parisah M Hussain
    Published on: 17 May 2020
  • Published on: (17 May 2020)
    Women’s experiences of diagnosis and management of polycystic ovary syndrome
    • Darmeena Gopikrishna, Foundation Year One Doctor, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh NHS Foundation Trust
    • Other Contributors:
      • Asha Kanwal, Foundation Year One Doctor
      • Parisah M Hussain, Medical Student

    Our interest in gynaecology attracted us to the study by Hillman et al. However, certain aspects need addressing. Firstly, we acknowledge that participants of the study were mainly White and British Asian. We believe this isn’t representative for patients with PCOS as it is more prevalent amongst women of BAME backgrounds.1. Therefore, splitting British Asian into subdivisions (such as Indian, Pakistani, Sri Lankan) would allow a better analysis of the variations existing between them; for example, dietary differences, cultural implications, etc. Having this information to hand will then enable addressing issues around mental health and fertility to be tackled with more targeted precision. We also understand that PCOS has a higher prevalence in patients with lower socio-economic backgrounds2 and therefore to widen the participant pool, surveys and interviews could be delivered in different languages and formats.

    An important aspect to consider is the criteria by which a diagnosis of PCOS was made. Many participants did not have a definitive diagnosis as recommended by NICE3 due to them self-diagnosing or having had a family member diagnose them implicating potential false-positive patients.

    Moreover, qualitative data analysed was based on patient recall. With a range as large as 10 years for a diagnosis to be made, there would be profound difficulties in recalling information given by doctors. We agr...

    Show More

    Our interest in gynaecology attracted us to the study by Hillman et al. However, certain aspects need addressing. Firstly, we acknowledge that participants of the study were mainly White and British Asian. We believe this isn’t representative for patients with PCOS as it is more prevalent amongst women of BAME backgrounds.1. Therefore, splitting British Asian into subdivisions (such as Indian, Pakistani, Sri Lankan) would allow a better analysis of the variations existing between them; for example, dietary differences, cultural implications, etc. Having this information to hand will then enable addressing issues around mental health and fertility to be tackled with more targeted precision. We also understand that PCOS has a higher prevalence in patients with lower socio-economic backgrounds2 and therefore to widen the participant pool, surveys and interviews could be delivered in different languages and formats.

    An important aspect to consider is the criteria by which a diagnosis of PCOS was made. Many participants did not have a definitive diagnosis as recommended by NICE3 due to them self-diagnosing or having had a family member diagnose them implicating potential false-positive patients.

    Moreover, qualitative data analysed was based on patient recall. With a range as large as 10 years for a diagnosis to be made, there would be profound difficulties in recalling information given by doctors. We agree that achieving triangulation using quantitative data was impressive, however this could be further improved by utilising data from GP surgeries to include official documentation of the diagnosis and management.

    To improve the study further, interviews/surveys could be done with the GPs who had diagnosed the patients. This would allow a comparison to be made about themes that arose as well understand how confident GP’s felt when delivering PCOS management.

    References
    1. Wolf WM, Wattick RA, Kinkade ON et al. Geographical Prevalence of Polycystic Ovary Syndrome as Determined by Region and Race/Ethnicity. Int J Environ Res Public Health 2018; 15(11):2589. 
    2. Merkin SS, Azziz R, Seeman T et al. Socioeconomic status and polycystic ovary syndrome. J Women’s Health 2011; (3): 413-419. 
    3. NICE CKS.  Polycystic ovary syndrome.  Available from: https://cks.nice.org.uk/polycystic-ovary-syndrome#!topicSummary [accessed 14 May 2020].

    Show Less
    Competing Interests: None declared.
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British Journal of General Practice: 70 (694)
British Journal of General Practice
Vol. 70, Issue 694
May 2020
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Women’s experiences of diagnosis and management of polycystic ovary syndrome: a mixed-methods study in general practice
Sarah C Hillman, Carol Bryce, Rachel Caleychetty, Jeremy Dale
British Journal of General Practice 2020; 70 (694): e322-e329. DOI: 10.3399/bjgp20X708881

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Women’s experiences of diagnosis and management of polycystic ovary syndrome: a mixed-methods study in general practice
Sarah C Hillman, Carol Bryce, Rachel Caleychetty, Jeremy Dale
British Journal of General Practice 2020; 70 (694): e322-e329. DOI: 10.3399/bjgp20X708881
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Keywords

  • diagnosis
  • general practice
  • patient experience
  • polycystic ovary syndrome

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