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PCOS: What’s the Gap in Patient and Physician Relationship?

  • Authors: News Author: Nancy A. Melville; CME Author: Charles P. Vega, MD
  • CME / ABIM MOC / CE Released: 9/12/2018
  • Valid for credit through: 9/12/2019, 11:59 PM EST
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Target Audience and Goal Statement

This article is intended for primary care physicians, obstetrician gynecologists, endocrinologists, nurses, pharmacists, and other physicians who care for women with polycystic ovary syndrome (PCOS).

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

Upon completion of this activity, participants will be able to:

  • Analyze how PCOS affects women’s quality of life (QoL)
  • Evaluate the perceptions of healthcare services among women with PCOS
  • Implications to the Healthcare Team


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News Author

  • Nancy A Melville

    Freelance writer, Medscape


    Disclosure: Nancy A. Melville has disclosed no relevant financial relationships.

CME Author

  • Charles P. Vega, MD, FAAFP

    Health Sciences Clinical Professor of Family Medicine, University of California, Irvine, California


    Disclosure: Charles Vega, MD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: Johnson & Johnson Pharmaceutical Research & Development, L.L.C.
    Served as a speaker or a member of a speakers bureau for: Shire Pharmaceuticals

Editor/CME Reviewer

  • Esther Nyarko, PharmD

    Associate CME Clinical Director, Medscape, LLC


    Disclosure: Esther Nyarko, PharmD, has disclosed no relevant financial relationships.

Nurse Planner

  • Amy Bernard, MS, BSN, RN-BC, CHCP

    Lead Nurse Planner, Medscape, LLC


    Disclosure: Amy Bernard, MS, BSN, RN-BC, CHCP, has disclosed no relevant financial relationships.

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PCOS: What’s the Gap in Patient and Physician Relationship?

Authors: News Author: Nancy A. Melville; CME Author: Charles P. Vega, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 9/12/2018

Valid for credit through: 9/12/2019, 11:59 PM EST


Clinical Context

Polycystic ovary syndrome is a disease state that might promote reduced QoL across several different health domains. Which of these domains is most important to women with PCOS? A previous study by Bazarganipour and colleagues addressed this issue. They reported their results in the April 2014 issue of the Journal of Sexual Medicine.[1]

Researchers performed a battery of tests regarding physical and psychological symptoms as well as assessments of health-related quality of life (HRQoL) among 300 women with PCOS. All study participants lived in Iran.

Women reported that the reproductive and menstrual effects of PCOS were the most dominant predictors of severity of disease, and they also had a significant effect on overall HRQoL. Self-esteem, body image, and sexual function (especially desire and arousal) were domains of HRQoL particularly affected by PCOS.

Patients with PCOS should receive empathic, supportive care that speaks to the physical, emotional, and social effects of illness. The current study by Lin and colleagues evaluates whether physicians are providing this type of care to women with PCOS in the United States.

Study Synopsis and Perspective

In a newly published survey, women with PCOS have expressed a heightened distrust in the opinions of primary care physicians (PCPs) -- but not specialists -- of their PCOS condition. 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 August 1 in the Journal of the Endocrine Society by Annie W. Lin, PhD, RD, Cornell University, Ithaca, New York, and colleagues.[2]

"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 at mean age of 27.8±5.2 years, to compare their impressions of their physicians and the general care the physicians provided.

The results showed that women with PCOS had significantly greater distrust of the PCPs' opinions compared with women 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

Polycystic ovary syndrome 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 has 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 (HCPs) were more inclined to argue with them about health-related issues vs the comparison group (P =.02).

Additionally, although participants reported rarely having negative encounters with their HCPs, the women with PCOS said they only sometimes were satisfied with the emotional support they received in their health care.

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

The authors speculated 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 by Dokras and colleagues that showed knowledge levels of PCOS varies between reproductive endocrinologists and gynecologists[3] and another study by Gibson-Helm and colleagues that revealed a substantial lag period between symptom onset and diagnosis of PCOS by multiple HCPs.[4]

In the latter study, women with PCOS commonly failed to receive information about PCOS and the dietary and physical activity behaviors that can benefit the condition. That study also showed many women with PCOS consulted 3 or more HCPs and waited more than 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 HCPs' provision of social support, and the findings suggest the need for a more attentive approach to PCOS, the authors reiterated.

"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," the authors suggested. "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," they concluded.

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. 2018;2:1001-1009.

Study Highlights

  • The observational study relied on data from an online survey promoted to women between the ages of 18 and 38 years. Women who reported being told by am HCP that they had PCOS were compared with women who reported predictable menstrual cycles every 21 to 35 days.
  • Women with a major chronic illness and women with isolated oligomenorrhea were excluded from the study analysis.
  • Researchers combined 2 published instruments of trust in physicians and beliefs about social support from HCPs. Their final survey comprised 28 questions regarding women’s experiences in healthcare settings over the past 3 years.
  • Final study results were adjusted to account for age, body mass index, and income.
  • 134 women with PCOS were compared with 198 women in a control group. The study cohort was 79% white, and 57% had a college degree. Most women were New York state residents.
  • Overall, women with PCOS had favorable opinions regarding the ability of PCPs and specialists to manage general health conditions.
  • Women with PCOS were more likely to trust the PCPs' prioritization of their health needs, but they were skeptical of PCPs' advice compared with the control group.
  • Women felt that specialists were generally superior to PCPs in the management of PCOS. Surveys showed that women with PCOS thought that PCPs emphasized general medical concerns over those of PCOS. Overall, there was a lack of specific dietary counseling related to PCOS.
  • Women with PCOS rarely had negative encounters in the healthcare setting, but their overall satisfaction with care was moderate, in part because they felt they could not have comfortable conversations about their concerns with their physician.
  • The PCOS cohort reported higher rates of arguing with their physician compared with the control group.

Clinical Implications

  • A previous study by Bazarganipour and colleagues found that self-esteem, body image, and sexual function (especially desire and arousal) were domains of HRQoL particularly affected by PCOS.
  • The current study by Lin and colleagues finds that women with PCOS rarely have negative experiences in healthcare settings, but there is a disconnection between patient and provider in terms of addressing the needs of women with PCOS. Women with PCOS felt that PCPs emphasized general medical care over PCOS, and PCOS was associated with greater distrust of the advice from PCPs.
  • Implications for the Healthcare Team: The current study demonstrates gaps in the complete care of women with PCOS. The healthcare team can be employed to address some of the personal and emotional concerns associated with PCOS specifically.

CME Post Test Questions

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