Objective: To identify the physician-, patient- and health-system-related factors that influence gynecologists’ decision to recommend endometrial sampling in young women (less than 40 years) with abnormal uterine bleeding
Study methods: A mail-based survey study was conducted using the Salant-Dillman method with 4 points of contact over 9 weeks. All Canadian obstetrician/gynecologists were initially surveyed (N=1746), receiving either French or English questionnaires. Eligible respondents were gynecologists practicing in Canada who treat these young women (N=834). Order response bias was taken into consideration by mailing two versions of the survey. Categorical data were analyzed using Pearson’s Chi-square statistics. A logistic regression with mixed effect model was performed to determine the odds of sampling the endometrium, using physician as random factor.
Results: Overall response rate was 56.5%. The majority of respondents were generalists (83.6%). 70.3% of respondents have had young patients with malignant or pre-malignant endometrial conditions. Physicians ≤ 39 years have had less experience with these patients (59.6%, p=0.002) as have physicians practicing in communities without ob/gyn residents (35.2%, p=0.006). Sampling method was predominantly by office pipelle (79.7%), with younger physicians and female respondents employing this method most frequently (p=0.0001).
In case scenarios which explored the importance of four patient-related risk factors (obesity, irregular cycles, nulliparity and older age), on the decision to sample, 98.8% of respondents would sample a young woman presenting with all four risk factors, as opposed to 8.8% who would sample if the patient did not have any of these characteristics. Obesity and irregular cycles was the next most important combination of risk factors prompting sampling in 87.3% of physicians.
In the logistic regression, the odds ratio to proceed with endometrial sampling was 2.23 (95% CI 1.64-3.03) if a physician had previous experience with young women diagnosed with endometrial cancer or a pre-malignant condition, and was 1.45 (95% CI 1.05-2.01) if the physician was female.
Conclusion: Patient and physician factors influenced the decision to proceed with sampling the endometrium of young women with abnormal uterine bleeding, whereas the health-system factors studied in this survey did not seem to play a strong role. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2010-07-14 15:06:07.786
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:OKQ.1974/5956 |
| Date | 06 August 2010 |
| Creators | PALERME, Stephanie |
| Contributors | Queen's University (Kingston, Ont.). Theses (Queen's University (Kingston, Ont.)) |
| Source Sets | Library and Archives Canada ETDs Repository / Centre d'archives des thèses électroniques de Bibliothèque et Archives Canada |
| Language | English, English |
| Detected Language | English |
| Type | Thesis |
| Rights | This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner. |
| Relation | Canadian theses |
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