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Is there a place for a molecular diagnostic test for pelvic inflammatory disease in primary care? An exploratory
Helen Bittleston1, Jane S Hocking1, Jane L Goller1
1Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
Introduction:
There is currently no test for pelvic inflammatory disease (PID) that is non-invasive and sufficiently sensitive and specific. Clinicians must therefore diagnose PID clinically, ruling out medical emergencies and conducting pelvic examinations where possible. While guidelines state that clinicians should be prepared to over-diagnose PID, it remains an under-diagnosed condition, with severe reproductive health impacts when left untreated. This research is the first to consider the perspectives of end-users on the development of a diagnostic test for PID.
Methods:
Semi-structured live video feed online (Zoom) interviews were conducted with 11 clinicians and nine women (aged 18-30 years) in Australia to understand how a diagnostic test might be used, and what characteristics a test would need for it to be acceptable to clinicians and young women. Participants were recruited via researcher and university student networks. Reflexive thematic analysis was used to identify key themes relating to the acceptability and characteristics of a diagnostic test for PID.
Results:
Seven general practitioners, four clinicians working in sexual health clinics, and nine young women (aged 21-27 years) were interviewed. Clinicians were aged between 31-58 years and were predominantly female. Clinicians recognised that the development of an accurate test to diagnose PID would be valuable to themselves and other clinicians, particularly those who lack experience diagnosing PID, and those working in certain settings, including emergency departments. They discussed how they might use a test to enhance their clinical assessment but highlighted that it would not replace clinical judgement. Clinicians also considered how a test would impact the patient experience and time to treatment, emphasising that it should be minimally invasive and have a quick turnaround time. Young women said a test would be acceptable if endorsed by a trustworthy clinician.
Conclusions:
PID remains a challenging diagnosis. Development of a minimally invasive and sufficiently accurate diagnostic test would be acceptable to young women and benefit some clinicians, although no test would completely replace an experienced clinician's judgement in making a PID diagnosis.
Insights
A new diagnostic test for pelvic inflammatory disease (PID) could be acceptable to young women and aid clinicians. This minimally invasive test would improve diagnosis but not replace clinical judgment for PID.
Area of Science:
- Reproductive Health
- Infectious Diseases
- Clinical Diagnostics
Background:
- Pelvic inflammatory disease (PID) diagnosis is challenging, relying on clinical assessment due to a lack of sensitive and specific non-invasive tests.
- Under-diagnosis of PID has severe reproductive health consequences.
- This study is the first to explore end-user perspectives on developing a PID diagnostic test.
Purpose of the Study:
- To understand clinician and young women's perspectives on the development and acceptability of a diagnostic test for PID.
- To identify essential characteristics for a PID diagnostic test to be accepted by end-users.
- To explore potential clinical utility and patient experience implications of a new PID diagnostic tool.
Main Methods:
- Semi-structured interviews were conducted online via Zoom with 11 clinicians (general practitioners and sexual health specialists) and 9 young women in Australia.
- Participants were recruited through researcher and university networks.
- Reflexive thematic analysis was employed to identify key themes regarding test acceptability and characteristics.
Main Results:
- Clinicians acknowledged the value of an accurate PID test, especially for less experienced practitioners and in settings like emergency departments.
- Clinicians indicated a new test would supplement, not replace, clinical judgment, and should be minimally invasive with rapid results.
- Young women found a test acceptable if recommended by a trusted clinician.
Conclusions:
- A minimally invasive and accurate diagnostic test for PID is likely to be acceptable to young women and beneficial for clinicians.
- While a new test can enhance clinical assessment and potentially speed up treatment, it will not entirely substitute the judgment of an experienced clinician in diagnosing PID.
- Further development of diagnostic tools is needed to address the challenges in PID diagnosis and its reproductive health impacts.
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