The use, quality and effectiveness of pelvic examination in primary care for the detection of gynaecological cancer

a systematic review

Research output: Contribution to journalArticle

Abstract

Background
Urgent suspected cancer referral guidelines recommend that women with gynaecological cancer symptoms should have a pelvic examination (PE) prior to referral. We do not know to what extent GPs comply, their competency at PE, or if PE shortens the diagnostic interval.

Objectives
We conducted a systematic review of the use, quality and effectiveness of PE in primary care for women with suspected gynaecological cancer.

Method
PRISMA guidelines were followed. Three databases were searched using four terms: PE, primary care, competency and gynaecological cancer. Citation lists of all identified papers were screened independently for eligibility by two reviewers. Data extraction was performed in duplicate and independently. Paper quality was assessed using the relevant Critical Appraisal Skills Programme checklist. Emergent themes and contrasting issues were explored in a narrative ecological synthesis.

Main Findings
Twenty papers met the inclusion criteria. 52% or less of women with suspicious symptoms had a PE. No papers directly explored GPs’ competence at performing PE. Pre-referral PE was associated with reduced diagnostic delay and earlier stage diagnosis. Ecological synthesis demonstrated a complex interplay between patient and practitioner factors and the environment in which examination is performed. Presenting symptoms are commonly misattributed by patients and practitioners resulting in misdiagnosis and lack of PE.

Conclusion
We do not know if pre-referral PE leads to better outcomes for patients. PE is often not performed for women with gynaecological cancer symptoms, and evidence that it may result in earlier stage of diagnosis is weak. More research is needed.
Original languageEnglish
Pages (from-to)378-386
Number of pages9
JournalFamily Practice
Volume36
Issue number4
Early online date28 Sep 2018
DOIs
Publication statusPublished - Aug 2019

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Gynecological Examination
Primary Health Care
Neoplasms
Referral and Consultation
Early Diagnosis
Guidelines
Diagnostic Errors
Checklist
Mental Competency
Databases

Keywords

  • GP
  • gynaecological cancer
  • PE
  • referral

Cite this

@article{8430fe83ca7b49fca9ca6c1e6d50d8e8,
title = "The use, quality and effectiveness of pelvic examination in primary care for the detection of gynaecological cancer: a systematic review",
abstract = "BackgroundUrgent suspected cancer referral guidelines recommend that women with gynaecological cancer symptoms should have a pelvic examination (PE) prior to referral. We do not know to what extent GPs comply, their competency at PE, or if PE shortens the diagnostic interval.ObjectivesWe conducted a systematic review of the use, quality and effectiveness of PE in primary care for women with suspected gynaecological cancer.MethodPRISMA guidelines were followed. Three databases were searched using four terms: PE, primary care, competency and gynaecological cancer. Citation lists of all identified papers were screened independently for eligibility by two reviewers. Data extraction was performed in duplicate and independently. Paper quality was assessed using the relevant Critical Appraisal Skills Programme checklist. Emergent themes and contrasting issues were explored in a narrative ecological synthesis.Main FindingsTwenty papers met the inclusion criteria. 52{\%} or less of women with suspicious symptoms had a PE. No papers directly explored GPs’ competence at performing PE. Pre-referral PE was associated with reduced diagnostic delay and earlier stage diagnosis. Ecological synthesis demonstrated a complex interplay between patient and practitioner factors and the environment in which examination is performed. Presenting symptoms are commonly misattributed by patients and practitioners resulting in misdiagnosis and lack of PE.ConclusionWe do not know if pre-referral PE leads to better outcomes for patients. PE is often not performed for women with gynaecological cancer symptoms, and evidence that it may result in earlier stage of diagnosis is weak. More research is needed.",
keywords = "GP, gynaecological cancer, PE, referral",
author = "Pauline Williams and Peter Murchie and Cruickshank, {Maggie E.} and Bond, {Christine M.} and Burton, {Christopher D.}",
note = "Acknowledgements: PW, PM, CMB and CDB contributed to the conception and design of the work, acquired and interpreted the data for the work, drafted the manuscript and revised it for important intellectual content, provided final approval for publication and agreed to be accountable for all aspects of the work. MEC interpreted the data for the work, drafted the manuscript and revised it for important intellectual content, provided final approval for publication and agreed to be accountable for all aspects of the work.",
year = "2019",
month = "8",
doi = "10.1093/fampra/cmy092",
language = "English",
volume = "36",
pages = "378--386",
journal = "Family Practice",
issn = "0263-2136",
publisher = "Oxford University Press",
number = "4",

}

TY - JOUR

T1 - The use, quality and effectiveness of pelvic examination in primary care for the detection of gynaecological cancer

T2 - a systematic review

AU - Williams, Pauline

AU - Murchie, Peter

AU - Cruickshank, Maggie E.

AU - Bond, Christine M.

AU - Burton, Christopher D.

N1 - Acknowledgements: PW, PM, CMB and CDB contributed to the conception and design of the work, acquired and interpreted the data for the work, drafted the manuscript and revised it for important intellectual content, provided final approval for publication and agreed to be accountable for all aspects of the work. MEC interpreted the data for the work, drafted the manuscript and revised it for important intellectual content, provided final approval for publication and agreed to be accountable for all aspects of the work.

PY - 2019/8

Y1 - 2019/8

N2 - BackgroundUrgent suspected cancer referral guidelines recommend that women with gynaecological cancer symptoms should have a pelvic examination (PE) prior to referral. We do not know to what extent GPs comply, their competency at PE, or if PE shortens the diagnostic interval.ObjectivesWe conducted a systematic review of the use, quality and effectiveness of PE in primary care for women with suspected gynaecological cancer.MethodPRISMA guidelines were followed. Three databases were searched using four terms: PE, primary care, competency and gynaecological cancer. Citation lists of all identified papers were screened independently for eligibility by two reviewers. Data extraction was performed in duplicate and independently. Paper quality was assessed using the relevant Critical Appraisal Skills Programme checklist. Emergent themes and contrasting issues were explored in a narrative ecological synthesis.Main FindingsTwenty papers met the inclusion criteria. 52% or less of women with suspicious symptoms had a PE. No papers directly explored GPs’ competence at performing PE. Pre-referral PE was associated with reduced diagnostic delay and earlier stage diagnosis. Ecological synthesis demonstrated a complex interplay between patient and practitioner factors and the environment in which examination is performed. Presenting symptoms are commonly misattributed by patients and practitioners resulting in misdiagnosis and lack of PE.ConclusionWe do not know if pre-referral PE leads to better outcomes for patients. PE is often not performed for women with gynaecological cancer symptoms, and evidence that it may result in earlier stage of diagnosis is weak. More research is needed.

AB - BackgroundUrgent suspected cancer referral guidelines recommend that women with gynaecological cancer symptoms should have a pelvic examination (PE) prior to referral. We do not know to what extent GPs comply, their competency at PE, or if PE shortens the diagnostic interval.ObjectivesWe conducted a systematic review of the use, quality and effectiveness of PE in primary care for women with suspected gynaecological cancer.MethodPRISMA guidelines were followed. Three databases were searched using four terms: PE, primary care, competency and gynaecological cancer. Citation lists of all identified papers were screened independently for eligibility by two reviewers. Data extraction was performed in duplicate and independently. Paper quality was assessed using the relevant Critical Appraisal Skills Programme checklist. Emergent themes and contrasting issues were explored in a narrative ecological synthesis.Main FindingsTwenty papers met the inclusion criteria. 52% or less of women with suspicious symptoms had a PE. No papers directly explored GPs’ competence at performing PE. Pre-referral PE was associated with reduced diagnostic delay and earlier stage diagnosis. Ecological synthesis demonstrated a complex interplay between patient and practitioner factors and the environment in which examination is performed. Presenting symptoms are commonly misattributed by patients and practitioners resulting in misdiagnosis and lack of PE.ConclusionWe do not know if pre-referral PE leads to better outcomes for patients. PE is often not performed for women with gynaecological cancer symptoms, and evidence that it may result in earlier stage of diagnosis is weak. More research is needed.

KW - GP

KW - gynaecological cancer

KW - PE

KW - referral

U2 - 10.1093/fampra/cmy092

DO - 10.1093/fampra/cmy092

M3 - Article

VL - 36

SP - 378

EP - 386

JO - Family Practice

JF - Family Practice

SN - 0263-2136

IS - 4

ER -