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.
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 language | English |
|---|---|
| Pages (from-to) | 378-386 |
| Number of pages | 9 |
| Journal | Family Practice |
| Volume | 36 |
| Issue number | 4 |
| Early online date | 28 Sept 2018 |
| DOIs | |
| Publication status | Published - Aug 2019 |
Bibliographical 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.Keywords
- GP
- gynaecological cancer
- PE
- referral
- DIAGNOSIS
- PAPANICOLAOU SMEARS
- YOUNG FEMALES
- PERFORMANCE
- DELAYS
- CERVICAL-CANCER
- OVARIAN-CANCER
Access to Document
- Accepted Manuscript
This is a pre-copyedited, author-produced version of an article accepted for publication in Family Practice following peer review. The version of record Pauline Williams, Peter Murchie, Maggie E Cruickshank, Christine M Bond, Christopher D Burton, The use, quality and effectiveness of pelvic examination in primary care for the detection of gynaecological cancer: a systematic review, Family Practice, Volume 36, Issue 4, August 2019, Pages 378–386, is available online at: https://doi.org/10.1093/fampra/cmy092.