Demographic and clinical characteristics determining patient-centeredness in endometriosis care

Demographic and clinical characteristics determining patient-centeredness in endometriosis care | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Demographic and clinical characteristics determining patient-centeredness in endometriosis care Hanna Grundström, Helena Kilander, Per Wikman, Matts Olovsson This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1993054/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Dec, 2022 Read the published version in Archives of Gynecology and Obstetrics → Version 1 posted 5 You are reading this latest preprint version Abstract Purpose: The primary aim of this study was to assess patient-centeredness of endometriosis care in a national sample of Swedish women with endometriosis. The secondary aims were to assess the importance of different dimensions of endometriosis care, and to analyze demographic and clinical determinants associated with the experience of patient-centeredness. Methods: This cross-sectional study including 476 women with confirmed endometriosis. An invitation to participate was sent to 1000 randomly selected women aged ≥18 years having any endometriosis diagnosis and who had visited a gynecological clinic due to endometriosis problems any time during the past five years. Participants were recruited from 10 different-sized gynecology clinics in different parts of Sweden. The invitation letter had a link to the digital survey, which consisted of demographic and clinical questions, and the ENDOCARE questionnaire (ECQ). ECQ measures experiences, importance and patient-centeredness of 10 dimensions of endometriosis care. Univariate and multiple regression analysis were used to analyze which patient-specific demographic and clinical determinants were associated with the experience of patient-centeredness. Results: The response rate was 48%. The results indicate that Swedish women with endometriosis experience low patient-centeredness, and rate relational aspects with healthcare professionals as the most important aspects of care. Having a gynecologist with patient responsibility was an independent predictor for high patient-centeredness. Conclusion: Women with endometriosis in Sweden experience low patient-centeredness, reflecting the urgent need for improvement. More effort should be given to develop the relational aspects of care. Women with endometrios should have a responsible gynecologist to care for treatment and follow-up. Endometriosis patient-centeredness ENDOCARE questionnaire ECQ What Does This Study Adds To The Clinical Work Overall, women were unsatisfied with the endometriosis care they had received during their lifetime, and they rated relational aspects with healthcare professionals as the most important parts of care. Endometriosis healthcare professionals should focus more on emotional support and continuity, since women having a gynaecologist with patient responsibility experienced a higher patient-centeredness. Introduction Endometriosis is a chronic, inflammatory gynecological disease affecting approximately 10% of all women in reproductive age [ 1 ]. In many cases, endometriosis has a negative effect on women’s health-related quality of life (HRQoL) [ 2 ], and is associated with lower emotional, physical, psychological, social and sexual health [ 3 , 4 ]. The most common symptoms are pain during menstruation and ovulation, during intercourse, urination or defecation, and also low back pain and chronic pelvic pain [ 5 ]. The “gold standard” for diagnosing endometriosis is a laparoscopy with histological confirmation of endometrial tissue [ 5 ]. Typically, it takes many years to get diagnosed [ 6 – 8 ]. During the road towards a diagnosis, women typically meet many different healthcare professionals and frequently describe encounters as problematic including normalization and trivialization of symptoms [ 9 – 11 ]. Given the challenges with the endometriosis care, there is room for quality improvements [ 12 , 13 ]. There is a growing body of knowledge on the benefits of quality improvement strategies when seeking to enhance healthcare services for chronic diseases [ 14 , 15 ]. The interest in improving patient-centeredness of endometriosis care has increased over the years, and is today promoted at legislative and healthcare regulatory levels [ 16 – 18 ]. For endometriosis, patient-centeredness is defined as a combination of understanding the burden of illness and treatment from patients’ points of view while still relying on scientific knowledge [ 19 ]. In quality improvement work, we need to identify which areas of endometriosis care are of importance to women, and identify patient-specific determinants associated with high patient-centeredness. This information can be used to raise healthcare professionals’ awareness to promote and preserve patient-centeredness, and to tailor care on an individual level. The primary aim of this study was to assess patient-centeredness of endometriosis care in a national sample of Swedish women with endometriosis. The secondary aims were to assess the importance of different dimensions of endometriosis care, and to analyze demographic and clinical determinants associated with the experience of patient-centeredness. Material And Methods Design This cross-sectional study was conducted in a national sample of Swedish women with endometriosis recruited from 10 gynecology clinics: three university hospitals, five county hospitals and two district hospitals. Sampling and data collection Inclusion criteria were women aged ≥ 18 years having any endometriosis diagnosis and who had visited the clinic due to endometriosis-related problems any time during the past five years. The 150 women who had most recently visited each clinic were selected, and out of this group, 100 were randomly selected. The 1000 women were invited by mail in September 2021. A reminder was send to those who had not responded within three weeks. The invitation letter included a link to the website containing the survey. The digital survey In 2011, the ENDOCARE questionnaire (ECQ) was designed to measure patient-centeredness of endometriosis care [ 20 ]. The digital survey consisted of ECQ, with the addition of three background questions: Do you have a responsible gynecologist to care for your endometriosis-related problems? Do you have a plan for treatment of endometriosis? Are you currently receiving desired care for endometriosis? The 38 statements in ECQ are answered on a four-point Likert scale on two dimensions: experience of the statement (disagree completely, disagree, agree, and agree completely) and personal importance of the statement (not important, fairly important, important, and of the utmost importance). The statements are clustered into 10 dimensions of patient-centeredness of endometriosis care: Respect for patient’s values, Preferences and needs, Coordination and integration of care, Information, communication and education, Physical comfort, Emotional support and alleviation of fear and anxiety, Involvement of significant others, Continuity and transition, Access to care, Technical skills and Endometriosis clinic staff. At the end, the patient is asked to grade her overall endometriosis care on a scale from very bad (0) to excellent (10). Three outcome measures are generated from the instrument. First, the percentage of negative experiences (PNP) is calculated on a 0 to 100 scale, with higher scores indicating worse performance. Then, the importance score (MIS) is calculated on a scale from 0 to 10, with higher scores indicating greater importance. From the PNP and MIS scores, a patient-centeredness score (PCS) is calculated and presented on a scale from 0 to 10, with higher scores indicating higher patient-centeredness [ 20 ]. The Swedish version of the ENDOCARE instrument has undergone psychometric validation and has been tested for reliability, with satisfactory results [ 21 ]. Statistical analysis Variables on continuous scales were described as mean and standard deviation (SD), and nominal data as frequency and percentage. To enable comparison with earlier research, MIS and PCS values are also presented as median and 25th and 75th percentiles. Missing answers were omitted in the calculations by changing the denominator in the equations for PNP, MIS and PCS. No participants had > 25% missing answers. To analyze which patient-specific demographic and clinical determinants are associated with the experience of patient-centeredness, univariate and multiple regression analysis were used. Determinants with a p < 0.2 in the univariate analysis were further analyzed in a multiple regression analysis using “enter” model building in order to detect and evaluate independent predictive factors for patient-centeredness [ 22 ]. Determinants were analyzed in relation to the 10 dimensions of patient-centeredness and to overall PCS. Nominal determinants with more than two categories were dichotomized. The degree of multicollinearity was tested for the determinants in each multiple model by examining the variance inflation factor (VIF). The VIFs for these determinants were < 5, which indicates that there was no considerable multicollinearity between the variables [ 23 ]. The following determinants were analyzed: age, ever given birth, higher education (university degree), currently in an intimate partner relationship, age at first symptoms of endometriosis, patient delay (time from symptom onset to seeking care), doctor delay (time from first seeking care to diagnosis), diagnostic delay (time from symptom onset to diagnosis), number of consultations with general practitioners before referral to gynecologist, moderate/severe self-reported stage of endometriosis, having a responsible gynecologist to care for endometriosis, having a plan for treatment of endometriosis, ever tried to conceive > 12 months and overall grading of endometriosis care. The level of statistical significance was set at p < 0.05. Regression coefficients (β) represent the mean change in the outcome variable (PCS score) for every 1-unit of change in the determinant, keeping all the other determinants constant. The explained variance of the multivariate models is presented by adjusted R 2 . Data were analyzed using IBM SPSS 28.0. Results In total, 476 women answered the digital survey, resulting in a response rate of 47.6%. Background characteristics and possible determinants of patient-centeredness are presented in Table 1 . Participants’ mean age was 36.5 years (range 18–60) and a majority had a university degree and were working full-time. Most women were currently in an intimate relationship and around half of them had children. The time between symptom onset and diagnosis (e.g. diagnostic delay) was 9.3 years. Around two out of three had a responsible gynecologist to care for endometriosis, a treatment plan and reported that they were currently receiving desired care. Table 1 Study participants’ background characteristics and possible determinants of patient-centredness (n = 476). n (%)* Mean (± SD) Age in years 36.5 ± 9 Highest level of education Compulsory school Secondary education University education 27 (6) 186 (39) 262 (55) Occupation Working full-time Working part-time Studying On sick leave Other 250 (53) 82 (17) 56 (12) 49 (10) 39 (8) Currently in an intimate partner relationship 365 (77) Ever tried to conceive > 12 months 163 (34) Has one or more child(ren) 240 (51) Age at first symptoms of endometriosis 19.4 ± 8 Years between first symptoms and search for help (patient’s delay) 3.3 ± 5 Years between first search for help and diagnosis (doctor’s delay) 6.5 ± 7 Years between first symptoms and diagnosis (diagnostic delay) 9.3 ± 8 Endometriosis complaints at diagnosis Dysmenorrhoea Dyspareunia Lower abdominal pain while not menstruating Infertility 440 (93) 285 (65) 389 (85) 144 (34) Endometriosis-related symptoms during the past year Dysmenorrhoea Dyspareunia Lower abdominal pain while not menstruating Infertility 273 (69) 283 (71) 379 (91) 101 (29) Stage of endometriosis (self-reported) Minimal/mild Moderate/severe 73 (15) 204 (73) Number of GP consultations before referral 6.8 ± 7 Having a responsible gynaecologist to care for endometriosis 315 (66) Having a plan for treatment of endometriosis 301 (63) Currently receiving desired care 293 (62) Grading of endometriosis care (scale 0–10) 4.2 ± 3 Would recommend current care to others 318 (67) *= % of valid answers, GP = general practitioner, SD = standard deviation As shown in Table 2 , the overall mean PCS score was 3.73, indicating a low patient-centeredness. The dimension with the highest PCS was “Endometriosis clinic staff” (mean 5.21) followed by “Respect for patients’ values, preferences and needs” (mean 5.09) and “Information, communication and education” (mean 4.81). The lowest PCS score was reported for the dimension “Emotional support and alleviation of fear and anxiety” (mean 0.85). Table 2 Mean importance and patient-centredness scores of the 10 dimensions of patient-centredness, and overall patient-centredness. Subscale of ECQ Mean (± SD) Median (25th percentile – 75th percentile) 1 Respect for patients’ values, preferences and needs MIS 9.34 (± 1.19) 10.00 (8.67–10.00) PCS 5.09 (± 3.72) 5.11 (2.44–8.67) 2 Coordination and integration of care MIS 7.02 (± 2.41) 7.33 (5.33–8.67) PCS 3.52 (± 2.88) 3.33 (1.00–5.33) 3 Information, communication and education MIS 8.67 (± 1.49) 9.20 (7.71–10.00) PCS 4.81 (± 2.81) 4.76 (2.65–7.09) 4 Physical comfort MIS 5.85 (± 2.76) 6.00 (4.50–8.00) PCS 4.16 (± 2.85) 4.00 (2.25–6.00) 5 Emotional support and alleviation of fear and anxiety MIS 7.09 (± 2.35) 7.33 (5.50–9.00) PCS 0.85 (± 1.54) 0.00 (0.00–1.50) 6 Involvement of significant others MIS 6.74 (± 2.61) 7.00 (4.00–9.00) PCS 0.99 (± 2.09) 0.00 (0.00–1.13) 7 Continuity and transition MIS 8.76 (± 1.62) 10.00 (7.33–10.00) PCS 4.61 (± 3.59) 4.22 (0.00–7.33) 8 Access to care MIS 8.31 (± 1.74) 8.67 (7.00–10.00) PCS 4.48 (± 2.97) 4.20 (2.25–6.67) 9 Technical skills MIS 9.02 (± 1.46) 10.00 (8.00–10.00) PCS 3.66 (± 3.23) 2.50 (0.00–6.00) 10 Endometriosis clinic staff MIS 9.05 (± 1.39) 10.00 (8.67–10.00) PCS 5.21 (± 3.62) 5.33 (2.89–8.67) Overall PCS PCS 3.73 (± 1.94) 3.46 (2.33–5.12) MIS = mean importance score, PCS = patient-centredness score, SD = standard deviation The dimension “Respect for patients’ values, preferences and needs” had the highest MIS mean score (9.34), i.e. it was experienced as the most important dimension. It was followed by “Endometriosis clinic staff” (mean 9.05) and “Technical skills” (9.02). “Physical comfort” and was experienced as the least important dimension (mean 5.85). In the univariate regression analysis between each determinant, PCS dimensions and overall PCS, several determinants were associated with PCS (Supplement 1). Table 3 shows the results of the multiple regression analyses for each determinant having a significant and independent influence on PCS. Overall grading of endometriosis care was the determinant associated with most PCS dimensions. Having a responsible gynecologist to care for the patient was an independent determinant for the PCS dimensions “Coordination and integration of care”, Information, communication and education”, “Emotional support and alleviation of fear and anxiety”, “Continuity and transition”, “Access to care” and for overall PCS (Table 3 ). Table 3 Beta coefficients and 95% confidence intervals (β (95%CI)) for the determinants of patient-centredness per PCS dimension and overall PCS in the multiple regression analyses. PCS1: Respect for patients’ values, preferences and expressed needs PCS2: Coordination and integration of care PCS 3: Information, communication and education PCS4: Physical comfort PCS5: Emotional support and alleviation of fear and anxiety PCS6: Involvement of significant others PCS7: Continuity and transition PCS8: Access to care PCS9: Technical skills PCS10: Endometriosis clinic staff Overall PCS Age - - - n.s n.s -0.03 (0.05— -0.01) - n.s n.s - n.s Ever given birth - - - - n.s - - - - - - Higher education n.s -0.81 (-1.41—0.20) - - n.s - - - - n.s n.s Currently in an intimate partner relationship - - - - - -0.80 (-1.33— -0.27) - n.s - - - Age at first symptoms n.s 0.06 (0.02—0.11) n.s n.s -0.04 (-0.06— − 0.01) - - n.s n.s n.s n.s Patient delay (years) - - - - - - - - - n.s - Doctor delay (years) n.s n.s n.s - n.s n.s - n.s n.s n.s n.s Diagnostic delay (years) n.s n.s n.s - -0.04 (-0.08— -0.01) n.s - - n.s n.s n.s No. of consultations with GPs before referral n.s n.s n.s -0.06 (0.10— -0.01) - - n.s n.s -0.05 (-0.10- -0.01) n.s n.s Moderate/severe self-reported stage of endometriosis n.s - - - - - - - n.s n.s n.s Having a responsible gynaecologist to care for endometriosis n.s 0.92 (0.21—1.63) 0.71 (0.09—1.32) n.s 0.63 (0.28—0.99) n.s 1.78 (0.98—2.58) 1.31 (0.70—1.91) n.s n.s 0.61 ( 0.17—1.05) Having a treatment plan n.s n.s n.s n.s n.s n.s 0.83 (0.42–1.62) n.s n.s n.s n.s Ever tried to conceive > 12 months - - - - n.s - - - - - - Overall grading of endometriosis care 0.80 (0.63—0.97) 0.22 (0.10—0.34) 0.54 (0.44—0.65) n.s 0.10 (0.04—0.16) 0.23 (0.15—0.31) 0.51 (0.38—0.64) 0.44 (0.34—0.53) 0.88 (0.75—1.02) 0.95 (0.80—1.11) 0.56 (0.49—0.64) Model p -value Adjusted R 2 < 0.001 0.49 < 0.001 0.11 < 0.001 0.31 < 0.001 0.05 < 0.001 0.12 < 0.001 0.12 < 0.001 0.27 < 0.001 0.27 < 0.001 0.49 < 0.001 0.50 < 0.001 0.64 n.s = not significant, GP = general practitioner Overall PCS had the highest explained variance (adjusted R 2 = 0.64) and was associated with having a specific gynecologist to care for endometriosis (β = 0.61) and overall grading of endometriosis care (β = 0.56). Although the dimension “Endometriosis clinic staff” had only one significantly associated determinant, overall grading of endometriosis care (β = 0.95), it had the highest explained variance (adjusted R 2 = 0.50). The dimension “Physical comfort” also had only one associated determinant, numbers of consultations with GPs before referral (β=-0.06), but the lowest explained variance (adjusted R 2 = 0.05) (Table 3 ). “Respect for patient´s values, preferences and expressed needs” had only one associated determinant, overall grading of endometriosis care (β = 0.80), but a relatively high explained variance (adjusted R 2 = 0.49). Both “Coordination and integration of care” and “Emotional support and alleviation of fear and anxiety” had four associated determinants. Three of the determinants were the same for both dimensions: age at first symptoms (β = 0.06 resp. β=- 0.04), having a responsible gynecologist to care for endometriosis (β = 0.92 resp. β = 0.63) and overall grading of endometriosis care (β = 0.22 resp. β = 0.10). However, the explained variances were relatively low for both models (adjusted R 2 = 0.11 resp. R 2 = 0.12) (Table 3 ). Having a higher education was associated with lower scores on the dimension “Coordination and integration of care” (β=-0.81), as was having an intimate partner relationship with scores on “Involvement of significant others” (β=-0.80). Discussion This is the first study to measure patient-centeredness and associated determinants in a larger national sample including several clinics of varying sizes. On average, the women's rating of overall PCS in this study was lower than what has been shown in previous comparable studies [ 16 , 24 ]. An explanation could be that our data is based on a national sample including university hospitals, county hospitals and district hospitals, while earlier studies collected data from specialized endometriosis centres [ 16 , 24 ]. Our results showed that “Respect for patients’ values, preferences and needs” and “Endometriosis clinic staff” were the two most patient-centered dimensions of endometriosis care, while “Emotional support and alleviation of fear and anxiety” had the lowest score. This is similar to earlier studies [ 16 , 24 ]. The items measuring “Respect for patients’ values, preferences and needs” and “Endometriosis clinic staff” mainly focus on healthcare professionals’ ability to meet their patients with respect, to invite them to participate in their own care and to be supportive and friendly. The items regarding “Emotional support and alleviation of fear and anxiety” are more focused on the psychological impact of endometriosis, the opportunity to consult a counsellor and if they are given information on a patients’ organization. Hence, it could indicate that healthcare professionals being respectful and friendly is not sufficient to alleviate fear and anxiety, and more concern should be given to provide emotional support. The lack of sufficient emotional support has been highlighted before [ 10 , 25 ]. The most important finding was the independent association between having a responsible gynecologist and several dimensions of PCS and overall PCS. The determinant of having a responsible gynecologist also had the highest β coefficients, meaning that it had more influence on PCS than the other determinants. Having a responsible gynecologist seem to increase the chances of experiencing patient-centeredness. In the literature, this has been described as the most responsible physician, who has the responsibility for the long- and short-term medical treatment of a patient, including follow-up and evaluation [ 26 ]. According to Swedish law, clinics are obligated to provide a most responsible physician if it is necessary to satisfy a patient’s safety, continuity and coordination of care. Therefore, most patients with chronic diseases have a most responsible physician. It could be argued, that, at least, all women with complex endometriosis should have a responsible gynecologist. This is something that could be highlighted in national and international guidelines. The National Guidelines for Endometriosis Care in Sweden [ 27 ] emphasize the importance of multi-professional teams working with the more complex cases, but there is limited implications of the guidance on the continuity of care. In the recently updated endometriosis guidelines from the European Society of Human Reproduction and Embryology, there is no implication of the structure of care [ 28 ]. In our sample, two thirds had a responsible gynecologist, indicating that most clinics have a routine regarding responsible gynecologists, but the issue warrants further investigation. Having a responsible gynecologist to care for endometriosis patients provides continuity in the contact with healthcare professionals. The importance of continuity has been noticed in endometriosis literature before, but to the best of our knowledge, this is the first study to show an association between continuity and patient-centeredness. Apers et al. [ 29 ] showed that the ECQ dimension “Continuity and transition” was associated with overall HRQoL and the experience of emotional well-being and social support. Moreover, continuity has been identified as a specific target for improvement of patient-centeredness in endometriosis care [ 24 , 29 ]. However, physicians should to bear in mind that continuity sometimes leads to a risk for tunnel vision thinking, which limits the holistic approach that is also often necessary to give proper care to women with complex endometriosis. Ideally, the care could be monitored by the responsible gynecologist in close cooperation with multiprofessional teams. The importance of a well-functioning relationship with healthcare professionals is also reflected in the MIS scores, where “Respect for patients’ values, preferences and needs”, “Information, communication and education”, “Continuity and transition”, “Technical skills” and “Endometriosis clinic staff” were the most important dimensions. “Physical comfort” was the least important aspect, indicating that improvement work should focus on relational aspects rather than comfort in the waiting room. Overall grading of endometriosis care was significant for overall PCS and for nine out of the ten dimensions of care. This suggests that a basic 0–10 grading scale can be used by healthcare professionals as a tool to obtain an indication of the experience of patient-centeredness in endometriosis care at their clinic. However ECQ is preferred for a thorough assessment of patient-centeredness in endometriosis care [ 16 ]. One strength of this study is that study participants constitute a random sample of women with confirmed endometriosis from ten different clinics of varying sizes from different parts of Sweden. All women had a confirmed endometriosis diagnosis, which seldom is the case in endometriosis research. Also, our population had a similar socioeconomic level as an age- and gender-matched population of Swedish women [ 30 ]. One limitation is the risk of self-selection bias, i.e. responding depends on experiences or satisfaction of care. Furthermore, ECQ can been criticized for risking a high recall bias, since women are obliged to answer with their entire care history in mind. The clinical implication of the results are that women with endometriosis could benefit from having a responsible gynecologist, and that clinics should organize their work around the idea of gynecologists having a handful of endometriosis patients to especially care for. Furthermore, possible interventions and actions to emotionally support women and alleviate fear and anxiety need more attention. Conclusion In conclusion, our results show that Swedish women with endometriosis experience low patient-centeredness, reflecting an urgent need for improvement. More effort should be given to develop the relational aspects of care and women with endometrios benefit from having a responsible gynecologist to care for treatment and follow-up. Given the random selection of participants from a national sample, the results should be generalizable to other countries with a similar organizational structure of healthcare. Declarations Acknowledgements We would like to thank all the respondents who answered the ECQ in our study. We would also like to thank all contact persons who helped us find eligible participants at their clinics: Anna-Sofia Melin at Capio Gynekologi Globen in Stockholm, Johanna Nordengren at Skåne University Hospital in Malmö, Måns Palmstierna Burenius at Sollefteå sjukhus in Sollefteå, Mattias Pålsson at Kvinnokliniken Carlanderska in Gothenburg, Eva Karin Sjömäling at Östersunds sjukhus in Östersund, Robin Wilding at Falu lasarett in Falun, and Mantre Öjersjö at Länssjukhuset i Kalmar in Kalmar. Funding The work was supported by grants from the Medical Research Council of Southeast Sweden and from Stiftelsen Tornspiran. The funding sources did not participate in any part of the study. 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Soc Sci Med 68:1489–1497. https://doi.org/10.1016/j.socscimed.2009.01.032 Dancet EAF, Ameye L, Sermeus W, Welkenhuysen M, Nelen WLDM, Tully L et al (2011) The ENDOCARE questionnaire (ECQ): a valid and reliable instrument to measure the patient-centeredness of endometriosis care in Europe. Hum Reprod 26:2988–2999. https://doi.org/10.1093/humrep/der277 Grundström H, Wikman P, Olovsson M (2021) Translation, cross-cultural adaptation and psychometric evaluation of the Swedish version of ENDOCARE – an instrument to measure patient-centeredness of endometriosis care. Gynecol Obstet Invest. https://doi.org/10.1159/000515659 Vittinghoff E, Glidden DV, Shiboski SC, McCulloch CE (2012) Regression Methods in Biostatistics: Linear, Logistic, Survival, and Repeated Measures Models (Statistics for Biology and Health), 2nd edn. Springer, Boston, MA Kim JH (2019) Multicollinearity and misleading statistical results. Korean J Anesthesiol 72:558–569. https://doi.org/10.4097/kja.19087 Dancet EAF, Apers S, Kluivers KB, Kremer JAM, Sermeus W, Devriendt C et al (2012) The ENDOCARE questionnaire guides European endometriosis clinics to improve the patient-centeredness of their care. Hum Reprod 27:3168–3178. https://doi.org/10.1093/humrep/des299 Young K, Fisher J, Kirkman M (2015) Women’s experiences of endometriosis: a systematic review and synthesis of qualitative research. J Fam Plan Reprod Heal Care 41:225–234. https://doi.org/10.1136/jfprhc-2013-100853 Sims S, Hewitt G, Harris R (2015) Evidence of a shared purpose, critical reflection, innovation and leadership in interprofessional healthcare teams: a realist synthesis. J Interprof Care 29:209–215 National Board of Health and Welfare (Socialstyrelsen) (2018) https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/nationella-riktlinjer/2018-12-27.pdf (accessed August 15, 2022) European Society of Human Reproduction and Embryology (2022) Endometriosis - Guideline of European Society of uman Reproduction and Embryology. Apers S, Dancet EAF, Aarts JWM, Kluivers KB, D’Hooghe TM, Nelen WLDM (2018) The association between experiences with patient-centred care and health-related quality of life in women with endometriosis. Reprod Biomed Online 36:197–205. https://doi.org/10.1016/j.rbmo.2017.10.106 Statistics Sweden (2022) Higher education in Sweden (Utbildningsnivån i Sverige). Stat Befolk 16–74 År Efter Kön, Ålder, Nationell Bakgrund, Utbildningsnivå Och Utbildningsinriktning År 2019–2020 [In Swedish] 2021. http://www.statistikdatabasen.scb.se/pxweb/sv/ssd/START__UF__UF0506/UtbSUNBefN/ Bate P, Robert G (2006) Experience-based design: from redesigning the system around the patient to co-designing services with the patient. Qual Saf Health Care 15:307–310. https://doi.org/10.1136/qshc.2005.016527 Supplementary Files Supplement1.docx Cite Share Download PDF Status: Published Journal Publication published 28 Dec, 2022 Read the published version in Archives of Gynecology and Obstetrics → Version 1 posted Reviewers agreed at journal 16 Sep, 2022 Reviewers invited by journal 28 Aug, 2022 Editor invited by journal 25 Aug, 2022 Editor assigned by journal 24 Aug, 2022 First submitted to journal 24 Aug, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1993054","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":132310344,"identity":"e62736ad-227d-4bb9-994c-9a384517b92b","order_by":0,"name":"Hanna Grundström","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIiWNgGAWjYBACAww2PztjAwlaDgBJyWaStRgcJuAwc/azxx78YKjNN7jdvPnzxz020caHmdskGP7Y4NRi2ZOXbtjDcNxyw51jZRIHnqXlbjvM2CbB2JaG22EHcswkeBiOGRjcyDFjOHDgMFRLA27nGZx/Yyb5B6LF+ANIy+ZmRpDD/uPWAjRcmoehBqTFQAKkZQMzSAvbATxa3phJyxgcMJC8kVYmceZAWu6Mw4zNFoltyXgclmMm+aaizoDvRvLmDxUHbHL729sf3vjwxw6nFqhGdM8mENAABHWElYyCUTAKRsHIBQBIlFmPsry9ZAAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0003-0260-8194","institution":"Linkopings universitet","correspondingAuthor":true,"prefix":"","firstName":"Hanna","middleName":"","lastName":"Grundström","suffix":""},{"id":132310345,"identity":"1b85c5fe-042e-49ad-ab5a-0ac466eb91a4","order_by":1,"name":"Helena Kilander","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Helena","middleName":"","lastName":"Kilander","suffix":""},{"id":132310346,"identity":"85b52ffc-cfc5-4b1f-aa27-0a60ed9ca1b4","order_by":2,"name":"Per Wikman","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Per","middleName":"","lastName":"Wikman","suffix":""},{"id":132310347,"identity":"bd9b8778-83d1-44e1-a437-db322c603111","order_by":3,"name":"Matts Olovsson","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Matts","middleName":"","lastName":"Olovsson","suffix":""}],"badges":[],"createdAt":"2022-08-24 08:46:36","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1993054/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1993054/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00404-022-06887-5","type":"published","date":"2022-12-28T18:07:18+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":44714984,"identity":"c26ab6df-06d6-4f5e-8be5-90d49e9a54ac","added_by":"auto","created_at":"2023-10-16 18:12:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":463052,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1993054/v1/8a99d513-be3a-446b-82e6-a7aa5d576541.pdf"},{"id":25861228,"identity":"fee89528-0534-458c-a3e0-fd0c6b249330","added_by":"auto","created_at":"2022-08-30 19:08:44","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":15103,"visible":true,"origin":"","legend":"","description":"","filename":"Supplement1.docx","url":"https://assets-eu.researchsquare.com/files/rs-1993054/v1/581f71ce4a9ecfb0be2e397f.docx"}],"financialInterests":"","formattedTitle":"Demographic and clinical characteristics determining patient-centeredness in endometriosis care","fulltext":[{"header":"What Does This Study Adds To The Clinical Work","content":"\u003cp\u003eOverall, women were unsatisfied with the endometriosis care they had received during their lifetime, and they rated relational aspects with healthcare professionals as the most important parts of care. Endometriosis healthcare professionals should focus more on emotional support and continuity, since women having a gynaecologist with patient responsibility experienced a higher patient-centeredness.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eEndometriosis is a chronic, inflammatory gynecological disease affecting approximately 10% of all women in reproductive age [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In many cases, endometriosis has a negative effect on women\u0026rsquo;s health-related quality of life (HRQoL) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], and is associated with lower emotional, physical, psychological, social and sexual health [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The most common symptoms are pain during menstruation and ovulation, during intercourse, urination or defecation, and also low back pain and chronic pelvic pain [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe \u0026ldquo;gold standard\u0026rdquo; for diagnosing endometriosis is a laparoscopy with histological confirmation of endometrial tissue [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Typically, it takes many years to get diagnosed [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. During the road towards a diagnosis, women typically meet many different healthcare professionals and frequently describe encounters as problematic including normalization and trivialization of symptoms [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGiven the challenges with the endometriosis care, there is room for quality improvements [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. There is a growing body of knowledge on the benefits of quality improvement strategies when seeking to enhance healthcare services for chronic diseases [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The interest in improving patient-centeredness of endometriosis care has increased over the years, and is today promoted at legislative and healthcare regulatory levels [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor endometriosis, patient-centeredness is defined as a combination of understanding the burden of illness and treatment from patients\u0026rsquo; points of view while still relying on scientific knowledge [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In quality improvement work, we need to identify which areas of endometriosis care are of importance to women, and identify patient-specific determinants associated with high patient-centeredness. This information can be used to raise healthcare professionals\u0026rsquo; awareness to promote and preserve patient-centeredness, and to tailor care on an individual level.\u003c/p\u003e \u003cp\u003eThe primary aim of this study was to assess patient-centeredness of endometriosis care in a national sample of Swedish women with endometriosis. The secondary aims were to assess the importance of different dimensions of endometriosis care, and to analyze demographic and clinical determinants associated with the experience of patient-centeredness.\u003c/p\u003e"},{"header":"Material And Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eThis cross-sectional study was conducted in a national sample of Swedish women with endometriosis recruited from 10 gynecology clinics: three university hospitals, five county hospitals and two district hospitals.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSampling and data collection\u003c/h2\u003e \u003cp\u003eInclusion criteria were women aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years having any endometriosis diagnosis and who had visited the clinic due to endometriosis-related problems any time during the past five years. The 150 women who had most recently visited each clinic were selected, and out of this group, 100 were randomly selected. The 1000 women were invited by mail in September 2021. A reminder was send to those who had not responded within three weeks. The invitation letter included a link to the website containing the survey.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eThe digital survey\u003c/h2\u003e \u003cp\u003eIn 2011, the ENDOCARE questionnaire (ECQ) was designed to measure patient-centeredness of endometriosis care [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe digital survey consisted of ECQ, with the addition of three background questions: Do you have a responsible gynecologist to care for your endometriosis-related problems? Do you have a plan for treatment of endometriosis? Are you currently receiving desired care for endometriosis?\u003c/p\u003e \u003cp\u003eThe 38 statements in ECQ are answered on a four-point Likert scale on two dimensions: experience of the statement (disagree completely, disagree, agree, and agree completely) and personal importance of the statement (not important, fairly important, important, and of the utmost importance). The statements are clustered into 10 dimensions of patient-centeredness of endometriosis care: Respect for patient\u0026rsquo;s values, Preferences and needs, Coordination and integration of care, Information, communication and education, Physical comfort, Emotional support and alleviation of fear and anxiety, Involvement of significant others, Continuity and transition, Access to care, Technical skills and Endometriosis clinic staff. At the end, the patient is asked to grade her overall endometriosis care on a scale from very bad (0) to excellent (10).\u003c/p\u003e \u003cp\u003eThree outcome measures are generated from the instrument. First, the percentage of negative experiences (PNP) is calculated on a 0 to 100 scale, with higher scores indicating worse performance. Then, the importance score (MIS) is calculated on a scale from 0 to 10, with higher scores indicating greater importance. From the PNP and MIS scores, a patient-centeredness score (PCS) is calculated and presented on a scale from 0 to 10, with higher scores indicating higher patient-centeredness [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Swedish version of the ENDOCARE instrument has undergone psychometric validation and has been tested for reliability, with satisfactory results [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eVariables on continuous scales were described as mean and standard deviation (SD), and nominal data as frequency and percentage. To enable comparison with earlier research, MIS and PCS values are also presented as median and 25th and 75th percentiles. Missing answers were omitted in the calculations by changing the denominator in the equations for PNP, MIS and PCS. No participants had\u0026thinsp;\u0026gt;\u0026thinsp;25% missing answers.\u003c/p\u003e \u003cp\u003eTo analyze which patient-specific demographic and clinical determinants are associated with the experience of patient-centeredness, univariate and multiple regression analysis were used. Determinants with a p\u0026thinsp;\u0026lt;\u0026thinsp;0.2 in the univariate analysis were further analyzed in a multiple regression analysis using \u0026ldquo;enter\u0026rdquo; model building in order to detect and evaluate independent predictive factors for patient-centeredness [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Determinants were analyzed in relation to the 10 dimensions of patient-centeredness and to overall PCS. Nominal determinants with more than two categories were dichotomized.\u003c/p\u003e \u003cp\u003eThe degree of multicollinearity was tested for the determinants in each multiple model by examining the variance inflation factor (VIF). The VIFs for these determinants were \u0026lt;\u0026thinsp;5, which indicates that there was no considerable multicollinearity between the variables [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe following determinants were analyzed: age, ever given birth, higher education (university degree), currently in an intimate partner relationship, age at first symptoms of endometriosis, patient delay (time from symptom onset to seeking care), doctor delay (time from first seeking care to diagnosis), diagnostic delay (time from symptom onset to diagnosis), number of consultations with general practitioners before referral to gynecologist, moderate/severe self-reported stage of endometriosis, having a responsible gynecologist to care for endometriosis, having a plan for treatment of endometriosis, ever tried to conceive\u0026thinsp;\u0026gt;\u0026thinsp;12 months and overall grading of endometriosis care.\u003c/p\u003e \u003cp\u003eThe level of statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Regression coefficients (β) represent the mean change in the outcome variable (PCS score) for every 1-unit of change in the determinant, keeping all the other determinants constant. The explained variance of the multivariate models is presented by adjusted R\u003csup\u003e2\u003c/sup\u003e. Data were analyzed using IBM SPSS 28.0.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eIn total, 476 women answered the digital survey, resulting in a response rate of 47.6%. Background characteristics and possible determinants of patient-centeredness are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Participants\u0026rsquo; mean age was 36.5 years (range 18\u0026ndash;60) and a majority had a university degree and were working full-time. Most women were currently in an intimate relationship and around half of them had children. The time between symptom onset and diagnosis (e.g. diagnostic delay) was 9.3 years. Around two out of three had a responsible gynecologist to care for endometriosis, a treatment plan and reported that they were currently receiving desired care.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStudy participants\u0026rsquo; background characteristics and possible determinants of patient-centredness (n\u0026thinsp;=\u0026thinsp;476).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)* Mean (\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge in years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.5\u0026thinsp;\u0026plusmn;\u0026thinsp;9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHighest level of education\u003c/p\u003e \u003cp\u003eCompulsory school\u003c/p\u003e \u003cp\u003eSecondary education\u003c/p\u003e \u003cp\u003eUniversity education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (6)\u003c/p\u003e \u003cp\u003e186 (39)\u003c/p\u003e \u003cp\u003e262 (55)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003cp\u003eWorking full-time\u003c/p\u003e \u003cp\u003eWorking part-time\u003c/p\u003e \u003cp\u003eStudying\u003c/p\u003e \u003cp\u003eOn sick leave\u003c/p\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e250 (53)\u003c/p\u003e \u003cp\u003e82 (17)\u003c/p\u003e \u003cp\u003e56 (12)\u003c/p\u003e \u003cp\u003e49 (10)\u003c/p\u003e \u003cp\u003e39 (8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrently in an intimate partner relationship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e365 (77)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEver tried to conceive\u0026thinsp;\u0026gt;\u0026thinsp;12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e163 (34)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas one or more child(ren)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e240 (51)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at first symptoms of endometriosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears between first symptoms and search for help (patient\u0026rsquo;s delay)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears between first search for help and diagnosis (doctor\u0026rsquo;s delay)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.5\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears between first symptoms and diagnosis (diagnostic delay)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.3\u0026thinsp;\u0026plusmn;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndometriosis complaints at diagnosis\u003c/p\u003e \u003cp\u003eDysmenorrhoea\u003c/p\u003e \u003cp\u003eDyspareunia\u003c/p\u003e \u003cp\u003eLower abdominal pain while not menstruating\u003c/p\u003e \u003cp\u003eInfertility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e440 (93)\u003c/p\u003e \u003cp\u003e285 (65)\u003c/p\u003e \u003cp\u003e389 (85)\u003c/p\u003e \u003cp\u003e144 (34)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndometriosis-related symptoms during the past year\u003c/p\u003e \u003cp\u003eDysmenorrhoea\u003c/p\u003e \u003cp\u003eDyspareunia\u003c/p\u003e \u003cp\u003eLower abdominal pain while not menstruating\u003c/p\u003e \u003cp\u003eInfertility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e273 (69)\u003c/p\u003e \u003cp\u003e283 (71)\u003c/p\u003e \u003cp\u003e379 (91)\u003c/p\u003e \u003cp\u003e101 (29)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage of endometriosis (self-reported)\u003c/p\u003e \u003cp\u003eMinimal/mild\u003c/p\u003e \u003cp\u003eModerate/severe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73 (15)\u003c/p\u003e \u003cp\u003e204 (73)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of GP consultations before referral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.8\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaving a responsible gynaecologist to care for endometriosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e315 (66)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaving a plan for treatment of endometriosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e301 (63)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrently receiving desired care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e293 (62)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrading of endometriosis care (scale 0\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWould recommend current care to others\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e318 (67)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003e*= % of valid answers, GP\u0026thinsp;=\u0026thinsp;general practitioner, SD\u0026thinsp;=\u0026thinsp;standard deviation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, the overall mean PCS score was 3.73, indicating a low patient-centeredness. The dimension with the highest PCS was \u0026ldquo;Endometriosis clinic staff\u0026rdquo; (mean 5.21) followed by \u0026ldquo;Respect for patients\u0026rsquo; values, preferences and needs\u0026rdquo; (mean 5.09) and \u0026ldquo;Information, communication and education\u0026rdquo; (mean 4.81). The lowest PCS score was reported for the dimension \u0026ldquo;Emotional support and alleviation of fear and anxiety\u0026rdquo; (mean 0.85).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean importance and patient-centredness scores of the 10 dimensions of patient-centredness, and overall patient-centredness.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubscale of ECQ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003cp\u003e(\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003cp\u003e(25th percentile \u0026ndash; 75th percentile)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 Respect for patients\u0026rsquo; values, preferences and needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.34 (\u0026plusmn;\u0026thinsp;1.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.00 (8.67\u0026ndash;10.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.09 (\u0026plusmn;\u0026thinsp;3.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.11 (2.44\u0026ndash;8.67)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 Coordination and integration of care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7.02 (\u0026plusmn;\u0026thinsp;2.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.33 (5.33\u0026ndash;8.67)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.52 (\u0026plusmn;\u0026thinsp;2.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.33 (1.00\u0026ndash;5.33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 Information, communication and education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e8.67 (\u0026plusmn;\u0026thinsp;1.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.20 (7.71\u0026ndash;10.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.81 (\u0026plusmn;\u0026thinsp;2.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.76 (2.65\u0026ndash;7.09)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4 Physical comfort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.85 (\u0026plusmn;\u0026thinsp;2.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.00 (4.50\u0026ndash;8.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.16 (\u0026plusmn;\u0026thinsp;2.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.00 (2.25\u0026ndash;6.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5 Emotional support and alleviation of fear and anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7.09 (\u0026plusmn;\u0026thinsp;2.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.33 (5.50\u0026ndash;9.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.85 (\u0026plusmn;\u0026thinsp;1.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00 (0.00\u0026ndash;1.50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6 Involvement of significant others\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e6.74 (\u0026plusmn;\u0026thinsp;2.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.00 (4.00\u0026ndash;9.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.99 (\u0026plusmn;\u0026thinsp;2.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00 (0.00\u0026ndash;1.13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7 Continuity and transition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e8.76 (\u0026plusmn;\u0026thinsp;1.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.00 (7.33\u0026ndash;10.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.61 (\u0026plusmn;\u0026thinsp;3.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.22 (0.00\u0026ndash;7.33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8 Access to care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e8.31 (\u0026plusmn;\u0026thinsp;1.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.67 (7.00\u0026ndash;10.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.48 (\u0026plusmn;\u0026thinsp;2.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.20 (2.25\u0026ndash;6.67)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9 Technical skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.02 (\u0026plusmn;\u0026thinsp;1.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.00 (8.00\u0026ndash;10.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.66 (\u0026plusmn;\u0026thinsp;3.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.50 (0.00\u0026ndash;6.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10 Endometriosis clinic staff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.05 (\u0026plusmn;\u0026thinsp;1.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.00 (8.67\u0026ndash;10.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.21 (\u0026plusmn;\u0026thinsp;3.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.33 (2.89\u0026ndash;8.67)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall PCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.73 (\u0026plusmn;\u0026thinsp;1.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.46 (2.33\u0026ndash;5.12)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eMIS\u0026thinsp;=\u0026thinsp;mean importance score, PCS\u0026thinsp;=\u0026thinsp;patient-centredness score, SD\u0026thinsp;=\u0026thinsp;standard deviation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe dimension \u0026ldquo;Respect for patients\u0026rsquo; values, preferences and needs\u0026rdquo; had the highest MIS mean score (9.34), i.e. it was experienced as the most important dimension. It was followed by \u0026ldquo;Endometriosis clinic staff\u0026rdquo; (mean 9.05) and \u0026ldquo;Technical skills\u0026rdquo; (9.02). \u0026ldquo;Physical comfort\u0026rdquo; and was experienced as the least important dimension (mean 5.85).\u003c/p\u003e \u003cp\u003eIn the univariate regression analysis between each determinant, PCS dimensions and overall PCS, several determinants were associated with PCS (Supplement 1). Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the results of the multiple regression analyses for each determinant having a significant and independent influence on PCS. Overall grading of endometriosis care was the determinant associated with most PCS dimensions. Having a responsible gynecologist to care for the patient was an independent determinant for the PCS dimensions \u0026ldquo;Coordination and integration of care\u0026rdquo;, Information, communication and education\u0026rdquo;, \u0026ldquo;Emotional support and alleviation of fear and anxiety\u0026rdquo;, \u0026ldquo;Continuity and transition\u0026rdquo;, \u0026ldquo;Access to care\u0026rdquo; and for overall PCS (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBeta coefficients and 95% confidence intervals (β (95%CI)) for the determinants of patient-centredness per PCS dimension and overall PCS in the multiple regression analyses.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePCS1:\u003c/p\u003e \u003cp\u003eRespect for\u003c/p\u003e \u003cp\u003epatients\u0026rsquo; values,\u003c/p\u003e \u003cp\u003epreferences and\u003c/p\u003e \u003cp\u003eexpressed needs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePCS2:\u003c/p\u003e \u003cp\u003eCoordination\u003c/p\u003e \u003cp\u003eand\u003c/p\u003e \u003cp\u003eintegration\u003c/p\u003e \u003cp\u003eof care\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePCS 3:\u003c/p\u003e \u003cp\u003eInformation,\u003c/p\u003e \u003cp\u003ecommunication\u003c/p\u003e \u003cp\u003eand education\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePCS4:\u003c/p\u003e \u003cp\u003ePhysical\u003c/p\u003e \u003cp\u003ecomfort\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePCS5:\u003c/p\u003e \u003cp\u003eEmotional\u003c/p\u003e \u003cp\u003esupport and\u003c/p\u003e \u003cp\u003ealleviation\u003c/p\u003e \u003cp\u003eof fear\u003c/p\u003e \u003cp\u003eand anxiety\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePCS6:\u003c/p\u003e \u003cp\u003eInvolvement of\u003c/p\u003e \u003cp\u003esignificant others\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePCS7:\u003c/p\u003e \u003cp\u003eContinuity and\u003c/p\u003e \u003cp\u003etransition\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003ePCS8:\u003c/p\u003e \u003cp\u003eAccess\u003c/p\u003e \u003cp\u003eto care\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003ePCS9:\u003c/p\u003e \u003cp\u003eTechnical\u003c/p\u003e \u003cp\u003eskills\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003ePCS10:\u003c/p\u003e \u003cp\u003eEndometriosis\u003c/p\u003e \u003cp\u003eclinic staff\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003cp\u003ePCS\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.03\u003c/p\u003e \u003cp\u003e(0.05\u0026mdash; -0.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEver given birth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHigher education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.81\u003c/p\u003e \u003cp\u003e(-1.41\u0026mdash;0.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCurrently in an intimate partner relationship\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.80\u003c/p\u003e \u003cp\u003e(-1.33\u0026mdash; -0.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge at first symptoms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003cp\u003e(0.02\u0026mdash;0.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.04\u003c/p\u003e \u003cp\u003e(-0.06\u0026mdash; \u0026minus;\u0026thinsp;0.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePatient delay (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDoctor delay (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiagnostic delay (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.04\u003c/p\u003e \u003cp\u003e(-0.08\u0026mdash; -0.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo. of consultations with GPs before referral\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.06\u003c/p\u003e \u003cp\u003e(0.10\u0026mdash; -0.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-0.05\u003c/p\u003e \u003cp\u003e(-0.10- -0.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eModerate/severe self-reported stage of endometriosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHaving a responsible gynaecologist to care for endometriosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003cp\u003e(0.21\u0026mdash;1.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003cp\u003e(0.09\u0026mdash;1.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003cp\u003e(0.28\u0026mdash;0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.78\u003c/p\u003e \u003cp\u003e(0.98\u0026mdash;2.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.31\u003c/p\u003e \u003cp\u003e(0.70\u0026mdash;1.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003cp\u003e( 0.17\u0026mdash;1.05)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHaving a treatment plan\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003cp\u003e(0.42\u0026ndash;1.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEver tried to conceive\u0026thinsp;\u0026gt;\u0026thinsp;12 months\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOverall grading of endometriosis care\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003cp\u003e(0.63\u0026mdash;0.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003cp\u003e(0.10\u0026mdash;0.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003cp\u003e(0.44\u0026mdash;0.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003en.s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003cp\u003e(0.04\u0026mdash;0.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003cp\u003e(0.15\u0026mdash;0.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003cp\u003e(0.38\u0026mdash;0.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003cp\u003e(0.34\u0026mdash;0.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003cp\u003e(0.75\u0026mdash;1.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003cp\u003e(0.80\u0026mdash;1.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003cp\u003e(0.49\u0026mdash;0.64)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eModel\u003c/b\u003e \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003ep\u003c/span\u003e\u003cb\u003e-value\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eAdjusted R\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;\u003cem\u003e0.001\u003c/em\u003e\u003c/p\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"12\"\u003en.s\u0026thinsp;=\u0026thinsp;not significant, GP\u0026thinsp;=\u0026thinsp;general practitioner\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOverall PCS had the highest explained variance (adjusted R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.64) and was associated with having a specific gynecologist to care for endometriosis (β\u0026thinsp;=\u0026thinsp;0.61) and overall grading of endometriosis care (β\u0026thinsp;=\u0026thinsp;0.56). Although the dimension \u0026ldquo;Endometriosis clinic staff\u0026rdquo; had only one significantly associated determinant, overall grading of endometriosis care (β\u0026thinsp;=\u0026thinsp;0.95), it had the highest explained variance (adjusted R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.50). The dimension \u0026ldquo;Physical comfort\u0026rdquo; also had only one associated determinant, numbers of consultations with GPs before referral (β=-0.06), but the lowest explained variance (adjusted R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). \u0026ldquo;Respect for patient\u0026acute;s values, preferences and expressed needs\u0026rdquo; had only one associated determinant, overall grading of endometriosis care (β\u0026thinsp;=\u0026thinsp;0.80), but a relatively high explained variance (adjusted R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.49).\u003c/p\u003e \u003cp\u003eBoth \u0026ldquo;Coordination and integration of care\u0026rdquo; and \u0026ldquo;Emotional support and alleviation of fear and anxiety\u0026rdquo; had four associated determinants. Three of the determinants were the same for both dimensions: age at first symptoms (β\u0026thinsp;=\u0026thinsp;0.06 resp. β=- 0.04), having a responsible gynecologist to care for endometriosis (β\u0026thinsp;=\u0026thinsp;0.92 resp. β\u0026thinsp;=\u0026thinsp;0.63) and overall grading of endometriosis care (β\u0026thinsp;=\u0026thinsp;0.22 resp. β\u0026thinsp;=\u0026thinsp;0.10). However, the explained variances were relatively low for both models (adjusted R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.11 resp. R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.12) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHaving a higher education was associated with lower scores on the dimension \u0026ldquo;Coordination and integration of care\u0026rdquo; (β=-0.81), as was having an intimate partner relationship with scores on \u0026ldquo;Involvement of significant others\u0026rdquo; (β=-0.80).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis is the first study to measure patient-centeredness and associated determinants in a larger national sample including several clinics of varying sizes. On average, the women's rating of overall PCS in this study was lower than what has been shown in previous comparable studies [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. An explanation could be that our data is based on a national sample including university hospitals, county hospitals and district hospitals, while earlier studies collected data from specialized endometriosis centres [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Our results showed that \u0026ldquo;Respect for patients\u0026rsquo; values, preferences and needs\u0026rdquo; and \u0026ldquo;Endometriosis clinic staff\u0026rdquo; were the two most patient-centered dimensions of endometriosis care, while \u0026ldquo;Emotional support and alleviation of fear and anxiety\u0026rdquo; had the lowest score. This is similar to earlier studies [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The items measuring \u0026ldquo;Respect for patients\u0026rsquo; values, preferences and needs\u0026rdquo; and \u0026ldquo;Endometriosis clinic staff\u0026rdquo; mainly focus on healthcare professionals\u0026rsquo; ability to meet their patients with respect, to invite them to participate in their own care and to be supportive and friendly. The items regarding \u0026ldquo;Emotional support and alleviation of fear and anxiety\u0026rdquo; are more focused on the psychological impact of endometriosis, the opportunity to consult a counsellor and if they are given information on a patients\u0026rsquo; organization. Hence, it could indicate that healthcare professionals being respectful and friendly is not sufficient to alleviate fear and anxiety, and more concern should be given to provide emotional support. The lack of sufficient emotional support has been highlighted before [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe most important finding was the independent association between having a responsible gynecologist and several dimensions of PCS and overall PCS. The determinant of having a responsible gynecologist also had the highest β coefficients, meaning that it had more influence on PCS than the other determinants. Having a responsible gynecologist seem to increase the chances of experiencing patient-centeredness. In the literature, this has been described as the most responsible physician, who has the responsibility for the long- and short-term medical treatment of a patient, including follow-up and evaluation [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. According to Swedish law, clinics are obligated to provide a most responsible physician if it is necessary to satisfy a patient\u0026rsquo;s safety, continuity and coordination of care. Therefore, most patients with chronic diseases have a most responsible physician. It could be argued, that, at least, all women with complex endometriosis should have a responsible gynecologist. This is something that could be highlighted in national and international guidelines. The National Guidelines for Endometriosis Care in Sweden [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] emphasize the importance of multi-professional teams working with the more complex cases, but there is limited implications of the guidance on the continuity of care. In the recently updated endometriosis guidelines from the European Society of Human Reproduction and Embryology, there is no implication of the structure of care [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In our sample, two thirds had a responsible gynecologist, indicating that most clinics have a routine regarding responsible gynecologists, but the issue warrants further investigation.\u003c/p\u003e \u003cp\u003eHaving a responsible gynecologist to care for endometriosis patients provides continuity in the contact with healthcare professionals. The importance of continuity has been noticed in endometriosis literature before, but to the best of our knowledge, this is the first study to show an association between continuity and patient-centeredness. Apers et al. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] showed that the ECQ dimension \u0026ldquo;Continuity and transition\u0026rdquo; was associated with overall HRQoL and the experience of emotional well-being and social support. Moreover, continuity has been identified as a specific target for improvement of patient-centeredness in endometriosis care [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. However, physicians should to bear in mind that continuity sometimes leads to a risk for tunnel vision thinking, which limits the holistic approach that is also often necessary to give proper care to women with complex endometriosis. Ideally, the care could be monitored by the responsible gynecologist in close cooperation with multiprofessional teams.\u003c/p\u003e \u003cp\u003eThe importance of a well-functioning relationship with healthcare professionals is also reflected in the MIS scores, where \u0026ldquo;Respect for patients\u0026rsquo; values, preferences and needs\u0026rdquo;, \u0026ldquo;Information, communication and education\u0026rdquo;, \u0026ldquo;Continuity and transition\u0026rdquo;, \u0026ldquo;Technical skills\u0026rdquo; and \u0026ldquo;Endometriosis clinic staff\u0026rdquo; were the most important dimensions. \u0026ldquo;Physical comfort\u0026rdquo; was the least important aspect, indicating that improvement work should focus on relational aspects rather than comfort in the waiting room.\u003c/p\u003e \u003cp\u003eOverall grading of endometriosis care was significant for overall PCS and for nine out of the ten dimensions of care. This suggests that a basic 0\u0026ndash;10 grading scale can be used by healthcare professionals as a tool to obtain an indication of the experience of patient-centeredness in endometriosis care at their clinic. However ECQ is preferred for a thorough assessment of patient-centeredness in endometriosis care [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOne strength of this study is that study participants constitute a random sample of women with confirmed endometriosis from ten different clinics of varying sizes from different parts of Sweden. All women had a confirmed endometriosis diagnosis, which seldom is the case in endometriosis research. Also, our population had a similar socioeconomic level as an age- and gender-matched population of Swedish women [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOne limitation is the risk of self-selection bias, i.e. responding depends on experiences or satisfaction of care. Furthermore, ECQ can been criticized for risking a high recall bias, since women are obliged to answer with their entire care history in mind.\u003c/p\u003e \u003cp\u003eThe clinical implication of the results are that women with endometriosis could benefit from having a responsible gynecologist, and that clinics should organize their work around the idea of gynecologists having a handful of endometriosis patients to especially care for. Furthermore, possible interventions and actions to emotionally support women and alleviate fear and anxiety need more attention.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, our results show that Swedish women with endometriosis experience low patient-centeredness, reflecting an urgent need for improvement. More effort should be given to develop the relational aspects of care and women with endometrios benefit from having a responsible gynecologist to care for treatment and follow-up. Given the random selection of participants from a national sample, the results should be generalizable to other countries with a similar organizational structure of healthcare.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all the respondents who answered the ECQ in our study. We would also like to thank all contact persons who helped us find eligible participants at their clinics:\u003c/p\u003e\n\u003cp\u003eAnna-Sofia Melin at Capio Gynekologi Globen in Stockholm, Johanna Nordengren at Sk\u0026aring;ne University Hospital in Malm\u0026ouml;, M\u0026aring;ns Palmstierna Burenius at Sollefte\u0026aring; sjukhus in Sollefte\u0026aring;, Mattias P\u0026aring;lsson at Kvinnokliniken Carlanderska in Gothenburg, Eva Karin Sj\u0026ouml;m\u0026auml;ling at \u0026Ouml;stersunds sjukhus in \u0026Ouml;stersund, Robin Wilding at Falu lasarett in Falun, and Mantre \u0026Ouml;jersj\u0026ouml; at L\u0026auml;nssjukhuset i Kalmar in Kalmar.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe work was supported by grants from the Medical Research Council of Southeast Sweden and from Stiftelsen Tornspiran. The funding sources did not participate in any part of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eH.G: study design, execution, analysis,\u0026nbsp;manuscript drafting and critical discussion.\u0026nbsp;H.K: study design,\u0026nbsp;manuscript drafting and critical discussion. P.W: analysis,\u0026nbsp;manuscript drafting and critical discussion.\u0026nbsp;M.O: study design, execution,\u0026nbsp;manuscript drafting and critical discussion.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki.\u0026nbsp;The study was approved by Swedish Ethical Review Authority on 10 November\u0026nbsp;2020, approval number 2020-0204.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBy answering the digital survey and sending their responses, participants gave their informed consent to participate.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAdamson D, Kennedy S, Hummelshoj L (2010) Creating solutions in endometriosis: global collaboration through the World Endometriosis Research Foundation. 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Qual Saf Health Care 15:307\u0026ndash;310. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/qshc.2005.016527\u003c/span\u003e\u003cspan address=\"10.1136/qshc.2005.016527\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-gynecology-and-obstetrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"arch","sideBox":"Learn more about [Archives of Gynecology and Obstetrics](https://www.springer.com/journal/404)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/arch/default.aspx","title":"Archives of Gynecology and Obstetrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Endometriosis, patient-centeredness, ENDOCARE questionnaire, ECQ","lastPublishedDoi":"10.21203/rs.3.rs-1993054/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1993054/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eThe primary aim of this study was to assess patient-centeredness of endometriosis care in a national sample of Swedish women with endometriosis. The secondary aims were to assess the importance of different dimensions of endometriosis care, and to analyze demographic and clinical determinants associated with the experience of patient-centeredness.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This cross-sectional study including 476 women with confirmed endometriosis. An invitation to participate was sent to 1000 randomly selected women aged ≥18 years having any endometriosis diagnosis and who had visited a gynecological clinic due to endometriosis problems any time during the past five years. Participants were recruited from 10 different-sized gynecology clinics in different parts of Sweden. The invitation letter had a link to the digital survey, which consisted of demographic and clinical questions, and the ENDOCARE questionnaire (ECQ). ECQ measures experiences, importance and patient-centeredness of 10 dimensions of endometriosis care. Univariate and multiple regression analysis were used to analyze which patient-specific demographic and clinical determinants were associated with the experience of patient-centeredness.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The response rate was 48%. The results indicate that Swedish women with endometriosis experience low patient-centeredness, and rate relational aspects with healthcare professionals as the most important aspects of care. Having a gynecologist with patient responsibility was an independent predictor for high patient-centeredness.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eWomen with endometriosis in Sweden experience low patient-centeredness, reflecting the urgent need for improvement. More effort should be given to develop the relational aspects of care. Women with endometrios should have a responsible gynecologist to care for treatment and follow-up. \u003c/p\u003e","manuscriptTitle":"Demographic and clinical characteristics determining patient-centeredness in endometriosis care","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-08-30 19:08:42","doi":"10.21203/rs.3.rs-1993054/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2022-09-16T06:30:32+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-08-28T21:07:11+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"Archives of Gynecology and Obstetrics","date":"2022-08-25T16:04:34+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2022-08-24T14:43:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Gynecology and Obstetrics","date":"2022-08-24T04:45:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-gynecology-and-obstetrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"arch","sideBox":"Learn more about [Archives of Gynecology and Obstetrics](https://www.springer.com/journal/404)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/arch/default.aspx","title":"Archives of Gynecology and Obstetrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"1ad5d5de-8b1e-4897-bcd7-bdbae0e275ed","owner":[],"postedDate":"August 30th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-10-16T18:09:03+00:00","versionOfRecord":{"articleIdentity":"rs-1993054","link":"https://doi.org/10.1007/s00404-022-06887-5","journal":{"identity":"archives-of-gynecology-and-obstetrics","isVorOnly":false,"title":"Archives of Gynecology and Obstetrics"},"publishedOn":"2022-12-28 18:07:18","publishedOnDateReadable":"December 28th, 2022"},"versionCreatedAt":"2022-08-30 19:08:42","video":"","vorDoi":"10.1007/s00404-022-06887-5","vorDoiUrl":"https://doi.org/10.1007/s00404-022-06887-5","workflowStages":[]},"version":"v1","identity":"rs-1993054","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1993054","identity":"rs-1993054","version":["v1"]},"buildId":"WvIrzKhiLBfengagbw6Ux","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}