Referral patterns for women with gynaecological symptoms: a national survey of gynaecologists

Poster

Ramanathan, S. A., Baratiny, G. Y., Stocks, N. P. and Searles, A. M.. 2011. "Referral patterns for women with gynaecological symptoms: a national survey of gynaecologists." 38th COSA Annual Scientific Meeting (COSA 2011). Perth, Australia 15 - 17 Nov 2011 United Kingdom.
Paper/Presentation Title

Referral patterns for women with gynaecological symptoms: a national survey of gynaecologists

Presentation TypePoster
AuthorsRamanathan, S. A. (Author), Baratiny, G. Y. (Author), Stocks, N. P. (Author) and Searles, A. M. (Author)
Journal or Proceedings TitleAsia Pacific Journal of Clinical Oncology
Journal Citation7 (4 (Supplement)), p. 126
Article Number231
Number of Pages1
Year2011
Place of PublicationUnited Kingdom
ISSN1743-7555
1743-7563
Web Address (URL) of Paperhttps://onlinelibrary.wiley.com/doi/10.1111/j.1743-7563.2011.01472.x
Conference/Event38th COSA Annual Scientific Meeting (COSA 2011)
Event Details
38th COSA Annual Scientific Meeting (COSA 2011)
Event Date
15 to end of 17 Nov 2011
Event Location
Perth, Australia
Abstract

Aim: To describe if and to whom gynaecologists refer women with symptoms attributable to endometrial, ovarian and vulval cancer and to identify patient and clinician factors predictive of referral.

Method: In a randomised incomplete block design, gynaecologists were presented with a randomised allocation of 12 vignettes, each containing a hypothetical scenario about a patient with gynaecological symptoms. Logistic
regression was used to estimate the odds of referrals being associated with study factors.

Results: Of the eligible 520 gynaecologists, 404 (77%) completed the vignettes online or returned their response by mail. Overall, 76% of endometrial vignettes, 75% of ovarian vignettes and 70% of vulval vignettes which had a high probability of cancer were referred; primarily to gynaecological oncologists (94%). For endometrial cancer, the two best predictors of referral were biopsy fi ndings of cancer (OR:13.8 95%CI 8.0–24.0) and the gender of the clinician (OR for female clinicians: 3.0 95%CI 1.8–5.2).
For ovarian cancer it was an elevated CA125 result (OR:12.2 95%CI 9.3–16.1) and ultrasound fi ndings of a solid cyst (OR:4.5 95%CI 3.6–5.7). For vulval cancer it was biopsy fi ndings of cancer (OR:232.0 95%CI 116.1–463.6) and presence of an ulcer (OR:2.0 95%CI 1.3–3.3). Private gynaecological
oncologist services could be accessed by 95% of metropolitan and 90% of rural gynaecologists; with 92% of these services associated with a cancer multidisciplinary team (MDT). Public gynaecological oncologist services
could be accessed by 94% of metropolitan and 97% of rural gynaecologists; with 97% associated with a MDT.

Conclusion: The results suggest variation in referral practices for women with gynaecological symptoms amongst gynaecologists and this variation does not appear to be associated with the presence or absence of Australian
evidence-based guidelines. There is a need for further research into understanding the basis of these differences including a review of the existing guidelines for ovarian cancer.

Keywordsgynaecologists; referrals; women's health; gynaecological symptoms
ANZSRC Field of Research 2020429999. Other health sciences not elsewhere classified
420319. Primary health care
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Byline AffiliationsUniversity of Newcastle
University of Adelaide
Institution of OriginUniversity of Southern Queensland
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