Elucidating behavioral and environmental barriers to clinicians’ engagement in endometriosis diagnostic practices: a mixed-methods scoping review

Endometriosis is an estrogen-dependent chronic systemic inflammatory disease that affects 10 % of people assigned female at birth. Despite its prevalence, mean diagnostic delay is 4-11 years. Although much research has involved patients, much less work has involved clinicians. Moreover, the studies that do exist have not been guided by a public health framework. Accordingly, this review leverages PRECEDE-PROCEED Model (PPM) Phase 3 to synthesize published studies on behavioral and environmental barriers to clinicians' engagement in endometriosis diagnostic practices. Five databases were searched. Studies that examined behavioral (e.g., knowledge, beliefs, attitudes) and environmental (e.g., lack of resources, lack of reinforcement) barriers to clinicians' engagement in endometriosis diagnostic practices, per the National Academy of Medicine, were included. Three investigators independently screened studies and extracted data, which were synthesized according to PPM Phase 3. Thirty-one studies were included. The most frequently reported barrier was lack of knowledge. Additional barriers included beliefs about and attitudes towards patients with endometriosis and/or their preferences that diverged from extant literature. For example, some clinicians believed that disclosing a diagnosis could trigger anxiety for patients, purportedly leading clinicians to withhold it as a diagnostic possibility. Environmental barriers (time constraints, lack of training, lack of access to obstetrician/gynecologists) also existed. Given the prevalence of endometriosis and complications, addressing diagnostic delay for endometriosis is critical. Solutions include not just more clinician education and training but interventions targeting clinician beliefs and attitudes, as knowledge alone is insufficient for behavior change. These changes must be considered within the environmental barriers discussed.