Patients With PCOS Lack Faith in Primary Care Physicians

Nancy A. Melville

August 02, 2018

Women with polycystic ovary syndrome (PCOS) have expressed a heightened distrust in primary care physicians' (PCPs) — but not specialists' — opinions of their condition in a newly published survey. The respondents also questioned the ability of general practitioners to address the social burdens of PCOS, underscoring the need for improved efforts to manage patients' concerns at the primary care level.

The research was published online August 1 in the Journal of the Endocrine Society by Annie W. Lin, PhD, RD, Cornell University, Ithaca, New York, and colleagues.

"Our study suggests that physicians can improve the patient–provider relationship by tailoring their advice to acknowledge the broad impact that PCOS has on women's lives, and to listen to patient concerns without judgment. These efforts can potentially bring about continuity of care for women with PCOS," said senior author Marla E. Lujan, PhD, also of Cornell University, in a statement by the Endocrine Society.

The researchers surveyed 332 women, including 134 with PCOS and 198 with regular menses a mean age of 27.8 years, to compare their impressions of their physicians and the general care they were receiving.

The results showed that women with PCOS had significantly greater distrust of the PCP's opinion compared to those with regular menses (P < .01).

Furthermore, patients with PCOS expressed the view that PCPs were not as well qualified to treat PCOS, compared with treatment of general health issues (P < .001).

Meanwhile, having PCOS was not associated with lower trust in specialists such as endocrinologists.

Arguments About Health-Related Issues, Lack of Emotional Support

PCOS affects 7% to 10% of women of reproductive age, making it the most common cause of infertility. The disorder can cause distressing symptoms such as irregular periods, weight gain, many small ovarian cysts, and excess hair, and it's been linked to other health conditions such as mental health disorders, type 2 diabetes, obesity, and heart disease.

In the survey, patients with PCOS indicated their healthcare providers were more inclined to argue with them about health-related issues versus the comparison group (P = .02).

And although participants reported rarely having negative encounters with their healthcare providers, the women with PCOS said they only sometimes were satisfied with the emotional support they received in their healthcare.

The women surveyed were enrolled in a larger observational study and completed a 28-item web-based survey that assessed their experiences over the past 3 years, called the I-PCOSM (Instrument for Polycystic Ovary Syndrome: Medical Experiences).

The authors speculate that differences in patients' perceptions of PCPs and specialists could largely relate to the different roles each have in patient management.

"We hypothesize that PCPs face greater feelings of distrust because they are at the frontline of healthcare delivery and frequently provide referrals when encountering medical conditions outside their usual scope of practice."

Backing the findings, other research has shed light on the inconsistent care patients with PCOS may receive, including a study that showed knowledge levels of PCOS varies between reproductive endocrinologists and gynecologists (Fertil Steril. 2017;107:1380-1386) and another study that revealed a substantial lag period between symptom onset and diagnosis of PCOS by multiple healthcare providers (J Clin Endocrinol Metab. 2017;102:604-612).

In the latter study, women with PCOS commonly failed to receive information about PCOS per se, as well as the dietary and physical activity behaviors that can benefit the condition.

That study also showed many women with PCOS consulted three or more healthcare providers and waited at least 2 years to be correctly diagnosed.

Importance of Specialty Referral Stressed

The new study is believed to be the first of its kind to directly explore PCOS patients' perceptions of the issues of trust and belief in their healthcare providers' provision of social support, and the findings suggest the need for a more attentive approach to PCOS, the authors reiterate.

"When interacting with a patient...we suggest that physicians consider tailoring their advice to acknowledge the unique challenges and concerns of women living with PCOS and listen to the patients without judgment," they suggest.

"Providing strong informational and emotional support may help reduce feelings of distrust between patients and physicians."

"We also recommend the importance of strengthening the specialty-referral process and identifying patient cues for when a referral may be the optimal approach when diagnosing and/or treating women at risk for PCOS."

The study received partial support from Cornell University grants from the Human Ecology Alumni Association and College of Agriculture and Life Sciences Alumni Association. The authors have reported no relevant financial relationships.

J Endocr Soc. Published online August 1, 2018. Full text

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