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Women with PCOS report lack of trust, emotional support in primary care

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August 1, 2018

Marla Lujan
Marla E. Lujan

Women with polycystic ovary syndrome are more likely to trust a specialist vs. a primary care provider to treat their PCOS-related concerns and report dissatisfaction overall with the level of emotional support they receive from their providers, according to new survey results published in the Journal of the Endocrine Society.

“PCOS is a complex medical condition that require life-long care as the condition evolves and/or a patient’s health care needs change,” Marla E. Lujan, MSc, PhD, associate professor in the division of nutritional sciences at Cornell University in Ithaca, New York, told Endocrine Today. “This lifelong interaction with health care professionals is crucial to improve health and wellness outcomes in women living with PCOS. Identifying areas for improvement in the patient-provider relationship is an important first step to ensuring a successful long-term partnership focused on providing patients with timely and appropriate care.”

In a cross-sectional study, Lujan and colleagues analyzed data from 134 women with PCOS and 198 women without PCOS recruited to complete an online survey regarding trust and social support towards health care providers, including primary care providers, specialists and nurse practitioners or physician assistants, as part of a larger, observational study comparing health-related behaviors in women with and without PCOS (mean age, 28 years; 79% white; 57% with college degree). Participants completed the Instrument for Polycystic Ovary Syndrome: Medical Experiences (I-PCOSM) between August 2014 and August 2016, which included 28 items to assess trust in physicians and beliefs about social supports from health care professionals, modified to assess perceptions of care over both general and PCOS-related concerns. Response options for trust in physicians ranged from “strongly disagree” to “strongly agree,” whereas options on social support ranged from “never” to “always.” Any score greater than 3.5 reflected greater agreement. Researchers used multiple linear regression models to examine the associations between PCOS diagnosis (independent variable) with trust and social support outcomes, and mixed-effect models to assess whether trust of physicians differed between types of health concerns.

Researchers found that women with PCOS believed their physicians, including primary care physicians and specialists, were well qualified to treat general health concerns and place patient medical needs above other considerations. However, women with PCOS reported greater distrust in the opinions offers by a primary care physician (P < .01) but reported greater confidence in a primary care provider’s prioritization of general health needs (P = .04).

Women with PCOS reported favorable scores when asked about trust in specialists to treat PCOS-related needs; however, women with PCOS reported their primary care provider placed “less effort” in treating PCOS issues vs. general health concerns (P < .001), whereas women with PCOS were less likely to believe that their primary care provider was well-qualified to treat PCOS concerns relative to general health concerns (P < .001).

Additionally, women with PCOS reported receiving general health advice from health care providers, but only sometimes received specific information about nutrition and PCOS, and only “sometimes” felt satisfied with the level of emotional report received.

“This research provides new and important evidence pertaining to deficiencies in trust and social support from health care providers that may contribute to negative medical experiences for patients with PCOS,” Lujan said. “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 listening to patient concerns without judgement — thus potentially bringing about continuity of care for women with PCOS.” – by Regina Schaffer

For more information:

Marla E. Lujan, PhD, can be reached at Cornell University, Department of Nutrition, 216 Savage Hall, Ithaca, New York 14853; email: mel245@cornell.edu.

Disclosure: The authors report no relevant financial disclosures.

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