Patient Education and Counseling 123 (2024) 108197

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Patient Education and Counseling

journal homepage: www.journals.elsevier.com/patient-education-and-counseling

Healthcare professionals’ perspectives on the challenges with managing

polycystic ovary syndrome: A systematic review and meta-synthesis
Minhui Guan a, b, 1, Rong Li a, b, 1, Binglu Wang a, b, Tan He a, b, Lan Luo a, b, Jinxin Zhao a, b, *,
Jun Lei a, **
a
Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University,138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan,China
b
Xiang Ya Nursing School of Central South University, 172 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, China

A R T I C L E I N F O A B S T R A C T

Keywords: Objective: To provide an overview of healthcare professionals’ experience of PCOS management and identify the
Barriers relevant facilitators and barriers.
Clinicians Methods: A systematic search was conducted in MEDLINE, EMBASE, CINAHL, Web of Science, and Cochrane
Facilitators
CENTRAL database from the earliest available date to April 2023. Qualitative and mixed methods studies that
Healthcare professionals
described healthcare professionals’ experiences of PCOS management were included.
Polycystic ovary syndrome
Results: A total of 74 findings were extracted from the 8 included studies, which were categorized into facilitators
and barriers. The barriers were meta-aggregated into four themes: the weakness of clinical evidence; women’s
low adherence to PCOS management; various obstacles that healthcare professionals face, and the influence of
social environment and culture. The facilitators were meta-aggregated into three themes: chronic disease
healthcare plan, communication techniques and healthcare professionals’ ability and awareness.
Conclusion: The findings of this study have the potential to improve the care provided to women with PCOS.
However, it is important for national health professionals and policy markers to consider the cultural context of
their own country when implementing these findings.
Practical implications: This study illustrated several challenges in managing the heterogeneous condition of PCOS
and provide insights for the development of medical policies and future research directions.

1. Background of symptoms with adolescent female development [10], the variable

Polycystic ovary syndrome (PCOS) is a common endocrine disorders
that affects women of reproductive age, with an incidence rate ranging
from 8% to13% [1]. PCOS is characterized by symptoms such as irreg­
ular menstruation, hirsutism, and acne. PCOS not only impacts ovula­
tion and fertility but also increases the risk of various health
complications, including diabetes, cardiovascular disease and tumors
[2–5]. Furthermore PCOS can also pose health risks to offspring [6–9].
Therefore, it is crucial to have timely diagnosis, active therapeutic
intervention and effective self-management strategies in place for
managing PCOS. Throughout this process, healthcare professionals play
a vital role.
Diagnosing PCOS can be challenging for clinicians due to the overlap
presentation of symptoms among patients, and the exclusivity of the
PCOS diagnosis [11]. As a result, clinicians are prone to the dilemma of
overdiagnosis and underdiagnosis [12]. In addition, clinicians from
different specialties, such as general medicine, endocrinology, gyne­
cology and reproduction, may have varing understandings of PCOS. This
variation can lead to differences in screening recommendations and
treatment plans based on their individual expertise [13–15].
Given the critical role of medical experts in PCOS management,
understanding their experiences is essential to developing effective
strategies and resources for implementing evidence-based guidelines for
PCOS management. A synthesis of published qualitative research is
considered to bring new understanding and additions to the topic and
provide insight and direction for future research. Therefore, the aim of

* Corresponding author at: Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District,
Changsha 410013, Hunan,China.
** Corresponding author.
E-mail addresses: 122184154@qq.com (J. Zhao), leijunbao@126.com (J. Lei).
1
Minhui Guan and Rong Li made equal contributions to this manuscript.

https://doi.org/10.1016/j.pec.2024.108197
Received 18 July 2023; Received in revised form 6 January 2024; Accepted 5 February 2024
Available online 12 February 2024
0738-3991/© 2024 Elsevier B.V. All rights reserved.
M. Guan et al. Patient Education and Counseling 123 (2024) 108197

this study is to examine existing qualitative research exploring health­
care professionals’ experience regarding PCOS management.
2. Method
This systematic review followed the Joanna Briggs Institute (JBI)
meta-synthesis approach [16] and was registered on PROSPERO on
April 20, 2022.
2.1. Literature search
We conducted a comprehensive search of MEDLINE, EMBASE,
CINAHL, Web of Science, and Cochrane CENTRAL databases from their
respective establishment dates up to April 2023. The search terms used
were ‘Polycystic ovary syndrome’, ‘PCOS’, ‘Health personnel’, ‘Physi­
cian* ’, ‘GP* ’, ‘Doctor’. No search filters were applied. Details of the
search strategies are shown in Supplementary 1. Reference lists of
included articles were also handsearched for eligible publications.
2.2. Eligibility criteria and study selection
Published qualitative empirical studies reporting on healthcare
professionals’ experiences of PCOS management were included in this
review. The inclusion and exclusion criteria are listed in Table 1. The
process of study selection is shown in the PRISMA diagram (Fig. 1). Two
researchers independently screened the studies, and any disagreements
during the screening process were resolved by discussion or recourse to a
third author.
2.3. Quality assessment
Eligible articles were assessed independently by three reviewers
using the Joanna Briggs Institute Qualitative Assessment and Review
Instrument (JBI-QARI)[17]. The instrument comprises of 10 questions,
each with a yes, no or uncertain answer. Studies with no or uncertain
answers to more than 5 questions were deemed to be of low quality and
were excluded from the review, as the lack of methodological rigor was
considered to undermine the credibility of the findings. However, all
eligible papers were included in this review. The assessment results are
shown in detail in Table 2.
process outlined by Thomas and Harden [18]. The findings were cate­
gorized according to their significance and then meta-aggregated to
generate synthesized findings[19]. Firstly, two reviewers used
line-by-line coding of the text in each finding to develop a bank of codes.
The coded data were re-examined to check for consistency of interpre­
tation. Secondly, the codes were grouped into different categories based
on their significance. Finally, the reviewers conducted an inductive
analysis of the categories to develop an interpretation that went beyond
the content of the original studies. These new analytical themes were
sufficiently developed to describe and/or explain all of the original
descriptive themes.
3. Result
3.1. Study characteristics
Our systematic search found 2702 articles from five databases, of
which 8 studies were included. These studies were conducted in
Australia (n = 5)[12,20–23]，India(n = 2) [24,25], and the United
States(n = 1) [26]. Different qualitative methods were used, the most
common being hermeneutics and/or phenomenology(n = 6) [12,20–23,
26], the rest being ethnography fieldwork (n = 2) [24,25]. The majority
of these studies fulfilled most of the criteria outlined by the Joanna
Briggs Institute, although they provided limited information regarding
the researcher’s stance and reflexivity. Across the 8 studies, data were
collected from 160 healthcare professionals, including gynecologists,
endocrinologists, general practitioners, nutritionists, dermatologists,
vaidyas, primary care providers (PCPs), homeopaths, exercise physiol­
ogists, and psychologists. The majority of the healthcare professionals
were female, and their years of experience in the field ranged from less
than 5 years to over 20 years.
3.2. Meta-synthesis of qualitative data
A total of 74 findings were extracted from the 8 included studies
(these findings are presented in Appendix 3). The findings were cate­
gorized into two overarching areas: facilitators and barriers (Table 3).
For barriers, findings were grouped into 10 categories based on simi­
larity of meaning, which were then meta-aggregated into four themes.
For facilitators, the findings were meta-aggregated into three themes.

2.4. Data extraction and synthesis 3.2.1. Barriers 1: the weakness of clinical evidence
The incomplete clinical evidence for approaches to managing PCOS
Three researchers independently extracted findings and assessed Some health professionals expressed concern about the guidelines,
their credibility. The data were analyzed using the thematic synthesis noting that they were lengthy but lacked sufficient detail, particularly in
providing specific lifestyle advice. In addition, there was limited clinical
evidence available on medication selection and regular screening for
Table 1
Article inclusion and exclusion criteria. long-term complications associated with PCOS.

Study Inclusion criteria Exclusion criteria “You give me 300 pages of guidelines I’m not going to read it.” (Arasu, A,
aspect Australia, p.4)
Design Qualitative methodology or Mixed-method studies with
“The guidelines that are out there are, are very broad. there’s no real
mixed methods predominantly quantitative
results strong conclusion about what to use, when to use, like the dose, the fre­
Aim/focus Explored the experience of Only focused on the disease quency, all of that kinda stuff. so my views are that there’s a lot more
disease management from experience of patients research needed to go into it. more long term research as well. (exercise
healthcare professionals’ physiologist) (Moran, Australia, p.1312)
perspectives
Article type Peer-reviewed journal articles / The absence of evidence-based PCOS-specific advice on the most appro­
and conference papers with
priate dietary or exercise approach was perceived to caused confusion for
complete information.
Language English /
women and some practitioners.“I think what people are looking for is
Participants Including doctors, nutritionists only patients actually very specific advice like, "you should eat this when." (Endocri­
and other healthcare nologist).(Chhour, Australia, p.2294)
professionals
Evidence Subjective reports with at least Reports based on recordings or Limitations on the practical use of diagnostic criteria Clinicians
one direct quote supporting the observations of the consultations tend to have two difficulties with diagnosis. One is that there have been
findings by the researcher, or no direct doubts about the diagnostic criteria. For another, the varied character­
quotes.
istics of disease can result in uncertainty when applying diagnostic

2
M. Guan et al. Patient Education and Counseling 123 (2024) 108197

Fig. 1. Flowchart of the search process (PRISMA).

Table 2
Quality assessment of the studies.
Citation Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Grade

Arasu, A., et al. [20] U Y Y Y Y N N Y Y Y B

Chhour, I., et al. [21] Y Y Y Y Y Y Y Y Y Y A
Copp, T., et al. [22] U Y Y Y Y Y Y Y Y Y B
Copp, T., et al. [12] U Y Y Y Y N Y Y Y Y B
Lee, I. T., et al. [26] U Y Y Y Y N N Y Y Y B
Moran, L. J., et al. [23] U Y Y Y Y Y Y Y Y Y B
Pathak, G. [25] Y Y Y Y Y N N Y Y Y B
Pathak, G. et al. [24] Y Y Y Y Y N N Y Y Y B

Q1. Is there congruity between the stated philosophical perspective and the research methodology?
Q2. Is there congruity between the research methodology and the research question or objectives?
Q3. Is there congruity between the research methodology and the methods used to collect data?
Q4. Is there congruity between the research methodology and the representation and analysis of data?
Q5. Is there congruity between the research methodology and the interpretation of results?
Q6. Is there a statement locating the researcher culturally or theoretically?
Q7. Is the influence of the researcher on the research, and vice-versa, addressed?
Q8. Are participants, and their voices, adequately represented?
Q9. Is the research ethical according to current criteria or, for recent studies, and is there evidence of ethical approval by an appropriate body?
Q10. Do the conclusions drawn in the research report flow from the analysis, or interpretation, of the data?
Y—Yes, N—No, U—Unclear.

criteria in the clinical diagnosis of PCOS. it’s patient-driven and it’s always hard to get people to actually go and do
the resource. We’re really good at making up new resources, but you’ve
I think the Rotterdam criteria are completely outdated and lead to an
got to get the person who’s got the metabolic problem to actually want to
almost, over- and misdiagnosis with significant consequences. There are
use the resource.”“No one wants to hear that if you exercise and eat
lots of women who are overdiagnosed or misdiagnosed with PCOS on the
healthily your acne will get better in maybe a year’s time. People want a
basis of irregular cycles and polycystic appearance of the ovaries on ul­
quick fix for that.” (Arasu, Australia, p.5)
trasound.’ (Gyn) (Copp, Australia, P663）
I see a lot of women who are struggling with. mental health. She’s dealing
The majority of clinicians also discussed how diagnosing PCOS in ado­
with work, she’s dealing with the busy husband. she’s dealing with mental
lescents is ‘fraught with danger’ as symptoms overlap with normal signs of
health. She cannot figure it out, how to plan the intake for their family for
pubertal development, so it is ‘reasonable to tread carefully with adoles­
that week. (dietitian) (Moran, Australia, p.1309)
cents and delay making a diagnosis’ (Copp, Australia, P663）
Some allied health professionals perceived individuals with PCOS as being
unmotivated to engage in lifestyle management for a variety of reasons,
3.2.2. Barriers 2: women’s low adherence to PCOS management
including being discouraged due to lack of results, having cravings due to
Lack of motivation Most healthcare professionals have identified
insulin resistance, or not enjoying physical activity.
that patients lack motivation for various reasons, including failed weight
loss attempts in the past and a belief that lifestyle interventions were . the big challenge would be motivation. (Moran, Australia, p.1311)
useless, which was cited as an important barrier to implementing PCSO
Lack of knowledge and resources for implementing management
management.
Patients’ lack of knowledge leads to misunderstandings and incorrect

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M. Guan et al. Patient Education and Counseling 123 (2024) 108197

Table 3 Healthcare professionals lack knowledge and training Healthcare

Facilities and barriers to the PCOS management. professionals expressed a lack of knowledge and training when it comes
Barriers Facilities to certain aspects of PCOS.
The weakness of The incompete clinical / Metabolic issues are difficult—I am not sure how much I should take on. I
clinical evidence evidence for approaches to do not think I have the time/resources/knowledge to manage. I believe
managing PCOS
PCPs do a better job.’’ (Gynecologist) (Lee, USA, p.98)
Limitations on the practical /
use of diagnostic criteria (Women with PCOS) need medications that I don’t really know how to
Women’s low Lack of motivation /
adherence to PCOS Lack of knowledge and /
navigate. Like sometimes metformin is used (for infertility), but I don’t
management resources for implementing have enough sophistication to know if they need certain doses or timing or
management when to pull it off. And I’ve never prescribed clomiphene.’’ (PCP) (Lee,
Various obstacles that Cognitive conflict of / USA, p.98)
healthcare responsibilities in different
professionals face departments ‘‘For women who have BMIs between 35 and 50—there’s other things
Healthcare professionals Healthcare we’re thinking about, maybe we’re not screening as much for their
reflect their lack of specific professionals ’ ability
menses, and so we miss it in the context of the diabetes. I could imagine
knowledge and training and awareness
Communication problems Communication that I don’t do the best job to screen for that.’’ (PCP) (Lee, USA, p.99)
with patients techniques
The influence of social Food culture /
Communication problems with patients Firstly, limited consultation
environment and Social life pattern / time restricts healthcare providers from providing detailed information
culture Health services system Chronic disease to patients, and hinders in-depth discussions. Secondly, when discussing
healthcare plan weight issues, it is crucial to consider the sensitivity of the topic and the
potential for weight shaming. Finally, there is a lack of long-term follow-
up to ensure continuity of clinician-patient communication.
treatmen choices, requiring healthcare professionals to invest consid­
erable time in dispelling these misconceptions. In addition, lack of re­ "It is a really hard thing to discuss to people, you know. It’s hard because it
sources (such as time, money, food, and space) is also a major barrier to is so emotionally laden.” (Arasu, A, Australia p.6)
implementing PCOS management.
“weight is very, very delicate topic to raise with anyone, typically a young
Infertility was the most common misconception, with most clinicians woman because there is a higher risk of women with PCOS having body
reporting that women read online or are told by a doctor that they will not image disorders or eating disorders. “(Endocrinologist). (Chhour, I,
be able to conceive naturally.‘They’re often being told they can’t get Australia, p.2295)
pregnant. That’s one of the most disturbing things I hear many times a
many have experienced weight stigma associated with being overweight.
day.’ (Gyn) (Copp, Australia, P664)
Unfortunately that often comes from medical professionals. (psycholo­
Allied health professionals reported that some individuals with PCOS have gist) (Moran, L, Australia, p.1311)
insufficient knowledge to manage their lifestyles, such as not knowing
a polycystic ovarian syndrome patient will be seen…in a general gyne­
“what a healthy diet looks like” (participant 1, dietitian) and minimal
cology clinic where…each doctor has to see five to ten patients in about
cooking skills, “they don’t know how to cook” (Moran, Australia,
three hours or so…doctors are pushed to see them quickly…we don’t
p.1308)
actually tell them very much about it [lifestyle management] [be]cause
(It’s) just the challenges I face with taking care of obese American pa­ we don’t have time” (Chhour, I, Australia, P2205)
tients. Diet, exercise, and the lack of good food resources. Not having
“I think getting patients to accept that this is actually a long-term illness
somewhere to exercise or walk—all of the problems that plague the
that is going to require ongoing input from their part like, you know, we’ve
population I take care of.’’ (PCP) (Lee, USA, p.98)
got tablets that help with things but it’s not a quick fix. It’s not something
Interviewees perceived that some individuals with PCOS were not able to that we can magically cure overnight.” (GP) (Copp, T, Australia P.722)
have a healthy lifestyle due to time constraints. In one example, this also
led to high frequency of eating out or takeaway.they always tell that
3.2.4. Barriers 4: the influence of social environment and culture
they’re busy and they have no time for exercise. (exercise physiologist)
Food culture Food culture is a significant factor that healthcare
(Moran, Australia, p.1309)
professionals in India emphasize when discussing the management of
PCOS in patients. In many households, women are responsible for the
3.2.3. Barriers 3: various obstacles that healthcare professionals face family’s diet, making it challenging for them to prepare meals that cater
Cognitive conflict of responsibilities in different departments to their own dietary needs as PCOS patients. In addition, parents of
Depending on their specialty and area of expertise, clinicians tend to adolescents with PCOS often resort to using inappropriate food rewards,
prioritize a specific aspect while potentially neglecting the patient’s which can hinder effective PCOS management. Finally, patients’
needs in other areas. distracted eating behaviors also lead them to overconsume calories.
But I’m not drilling down [on lifestyle changes]. They’re not paying me, as Who is deciding the diet? They [the family] order a chicken bir­
a specialist, to spend time with them, actually going through how to yani—somebody has to finish it. She [the woman] is finishing leftovers,
achieve those weight, lifestyle changes.” – Ob/Gyn-1 (general popula­ eating the wrong food, and catering to so many people. She can’t cook a
tion). (Chhour, Australia, p.2295) healthy meal. If she cooks a salad, the mother-in-law says ‘You are
starving my son! (Pathak, G, Indian, P15)
‘‘I do ask about menses in the annual, but many just come for sick visits
and so we may not talk about their periods for a few years.’’ (PCP) (Lee, Meanwhile, this is a highly stressful time for students, and interactions in
USA, p.98) the city revealed that eating is one of the only socioculturally sanctioned
outlets; in fact, parents often use calorie-dense treats to both reward and
‘It doesn’t really matter to me [whether PCOS is diagnosed or not]. It’s
motivate gruelling study session. (Pathak, G, Indian, P8)
more a case of whether they’re ovulating or not.’ (Gyn)(Copp, T,
Australia, P664)

4
M. Guan et al.
These days, people, even when eating, they sit in front of the TV and eat.
Meaning what happens is that there is actually no attentiveness to the
food. Food is there, no? That has to be chewed 32 times. That makes a
difference. But then you are eating while watching TV or on one side you
are working on your laptop and another side you are eating. (Pathak &
Nichter, Indian, P24)
Social life pattern Women’s social role requires them to bear all
kinds of pressures. Meanwhile, some women’s self-strengthening char­
acter increases this pressure. Additionally, the modern lifestyle con­
tributes to irregular work schedules, lack of physical activity, and an
overwhelming amount of unorganized health information for women.
Dr. Gopalan, a gynecologist, highlighted examination stress: “Lot of stress
in the lifestyle. There is a lot of education stress, any stress of that kind.”
Another aspect of stress to come up was that of the stress caused by
women’s aspirations, as they demanded more of themselves and then were
under the pressure of their own expectations. (Pathak & Nichter, Indian,
P25)
Dr. Prasad talked of the fact that, “Nowadays teenagers have a lot of
distractions. They are constantly getting engaged because of internet and
social media like Facebook,” which contributed to disturbed circadian
rhythms, affecting the regularity of hormonal and menstrual cycles.
(Pathak & Nichter, Indian, P24)
And there is a lot of peer pressure, there is a lot of pressure regards to
work, and in India, of course, work is totally done by the woman, nobody
is going to share the work, the household work. And then they are earning
alsodI mean the financial aspect and the work outside is of course also
there, so it’s double work. That is a lot of stress. (Pathak & Nichter, In­
dian, P25)
Health services system Firstly, regional restrictions limit patients’
access to allied health services. Secondly, there is a lack of an established
multidisciplinary care model that promotes collaboration and integra­
tion among healthcare providers. Finally, financial constraints on the
healthcare system, reimbursement systems related to consultation time,
and other issues hinder disease management and long-term follow-up.
“There are huge barriers in terms of regional areas. some of the places if
I’m referring to see a dietitian. it may be three-plus months before they
could potentially get into see somebody.” (Arasu, A, Australia, p.4)
‘‘I am not clear on the benefit of metformin. I have consulted family
medicine about metformin, and they also do not think it should be started.
I wish I had better access to a nutritionist for PCOS.’’ (Gynecologist) (Lee,
USA, p.98)
if you’ve got five or six different practitioners all telling you slightly
different things, it may make you more confused. Well if they’ve got an
endocrinologist talking about. how different things impact their hormones
or balances like that and then you’ve got the GP talking about different
medications for insulin resistance. and sending you onto dietary and
exercise physiology and then you’ve got the psychologist talking about
how to deal with chronic disease, then you’ve got yet the dietitian telling
you what they should eat and there’s, it would be a lot of changes to make
all at the same time. (exercise physiologist) (Moran, L, Australia,
p.1312)
“The way the Medicare schedule is certainly set up is you’re rewarded for
seeing people for short periods of time.”“I don’t think it rewards those
GP’s who are really thorough and want to try to address and cover all the
issues that are there. I think, unfortunately, those doctors are penalised.”
(Arasu, A. Austarlia, p.5)
3.2.5. Facilities
Chronic disease healthcare plan Multidisciplinary teamwork and
referral plans play an important role in chronic disease management
plans.
5
Patient Education and Counseling 123 (2024) 108197
“There are some systems in place, like, chronic disease management plans
that we can use to refer patients off to dietitians or exercise physiologists
so I guess that’s one positive thing that’s out there.” (Arasu, A. Austarlia,
p.6)
Interviewees expressed that this approach would allow health pro­
fessionals and GPs to provide ongoing support with lifestyle management
where specialists could not.
“Most of my patients I generally make sure that they are under a chronic
disease healthcare plan with their GP so that allows them to access allied
health support… for example, they could see a psychologist, an exercise
physiologist or a dietitian.” - Endocrinologist-7 (general population).
(Chhour, I, Australia, p.2295)
“I think a GP is a great person to help coordinate that care, because they
provide holistic care.” (Arasu, A. Austarlia, p.6)
Communication techniques Participants reported that some patients
were eager to become pregnant. Understanding patients’ needs in
communication and using some communication skills and motivational
interviewing could better promote patient readiness.
“That’s a big motivating factor for women. You know, one of the primary
reasons, I think, they come and see you, as a GP, is because they’re trying
to get pregnant.” (Arasu, A. Austarlia, p.6)
Ob/Gyns reported that lifestyle changes were more successful when
women used it as means to improve fertility or pregnancy outcomes. “…
we often say, ‘pregnancy is a massive time to get women to change be­
haviors because they feel like they’re doing it for something.” (Ob/Gyn).
(Chhour, I. Australia, P2295)
“I think that’s where motivational interviewing comes in, and that’s a skill
that GPs often do have, which is a way of discussing with patients, and
eliciting their own motivation for activity.” (Arasu, A. Austarlia, p.6)
healthcare professionals ’ ability and awareness Most healthcare
professionals have excellent skills and are willing to help improve PCOS
management.
“I very much try and come back and individualise it for women, what this
means for them rather than just endure one-size-fits-all.” (Endo) (Copp,
T, Australia, P.723)
‘‘I explain what it is and print something out for them to go home and
read. Then if they have questions, we can follow-up.’’ (PCP) (Lee, USA,
p.99)
there needs to be more advocacy that the work that. dietitians and ex­
ercise physiologists. or the role that we can play in PCOS management.
(participant 3, dietitian) (Moran, L. Australia, p.1312)
4. Discussion and conclusion
4.1. Discussion
This review synthesized literature exploring healthcare pro­
fessionals’ experiences of PCOS management and suggested several
salient factors influencing implementation of PCOS management. The
barriers categorized into four themes: the weakness of clinical evidence;
women’s low adherence to PCOS management; various obstacles that
healthcare professionals face; the influence of social environment and
culture. The facilitators encompassed chronic disease healthcare plans,
communication techniques and healthcare professionals’ ability and
awareness.
We identified gaps in the existing clinical evidence. Firstly, limited
clinical evidence exists to guide drug selection and to monitor long-term
complications. Although there is a well-established clinical approach to
infertility in women with PCOS [27],the available clinical evidence
regarding drug selection for other symptoms remains limited. A
M. Guan et al.
systematic review was conducted to evaluate the efficacy and safety of
metformin versus oral contraceptives(alone or in combination) for hir­
sutism, acne, and menstrual pattern in PCOS wemon, but it failed to
draw a definitive conclusion due to either no evidence or very
low-quality evidence [28]. PCOS medication guidelines also acknowl­
edge the restricted quality of existing clinical evidence and advise
caution in drawing conclusions [29]. Secondly, while there is evidence
supporting the necessity of regularly screening women with PCOS for
long-term health risks [29,30], the frequency of screening and the spe­
cific populations for whom it is recommened need to be further clarified,
given the financial burden on the patients. Finally, Consistent with
previous studies [31], there is debate about the benefits and harms of
overdiagnosis and underdiagnosis, highlighting the importance of
effective communication with patients after diagnosis. Healthcare pro­
fessionals should help patients learn about PCOS and emphases the
importance of adopting a health lifestyle. Future clinical guidelines
should take into account the need for individualized treatment and help
clinicians to provide specific treatment and management of PCOS based
on the unique circumstances of each patient. Future studies could focus
on specifing long-term complication screening for PCOS in a
cost-effective manner.
Consistent with previous studies [32,33], women with PCOS
exhibited lower adherence to their management plan, which was pri­
marily attributed to lack of motivation, inadequate knowledge, and
limited access to resources necessary for effective implementation. As
reported in recent studies, insufficient motivation among PCOS women
has been identified as a significant barrier to successful implementation
of lifestyle management by healthcare providers [34]. Clinicians can use
motivational interviewing to promote compliance in women with PCOS.
There is moderate quality evidence supporting the beneficial effects of
motivational interviewing in increasing physical activity in patients
with chronic health conditions [35]. Early cross-sectional studies have
indicated that women generally have inadequate knowledge about
PCOS, and factors such as education level, place of residence, occupation
and marital status have been identified as influential elements [36,37].
Therefore, to improve the knowledge and management capacity of PCOS
patients, it is recommended that the government provides comprehen­
sive educational resources and then executes extensive education and
publicity campaigns. Researchers can also focus on developing specific
interventions that can help PCOS patients improve their motivation and
management of change. This could involve creating more targeted
educational programs, providing accessible resources and support, and
enhancing communication and collaboration between clinicians and
patients.
This study revealed the various obstacles that healthcare pro­
fessionals face. The first is the cognitive conflict of responsibility among
clinicians from different departments. We found that PCPs did not
consider it necessary to address menstrual problems, fertility clinicians
did not take PCOS diagnosis seriously, and lifestyle management was
thought to be provided by allied health professionals. This disparity in
perceived responsibility has been reported in previous quantitative
studies. Previous studies tended to explore the differences in diagnosis
and treatment approaches adopted by gynecologists and endocrinolo­
gists [13,15,38]. The results indicated that there was a lack of consensus
between endocrinologists and gynecologists regarding definition, diag­
nosis and treatment of PCOS. As a consequence, women may receive a
varying diagnoses or treatments depending on the specialist they con­
sulted. Secondly, healthcare professionals also reported a lack of specific
knowledge and training, especially in a field different from their spe­
cialty. Previous quantitative studies also showed that most respondents
lack awareness regarding the what diagnostic criteria they use and the
long-term complications of PCOS [39,40]. Increasing interdisciplinary
collaboration and education among clinicians with different specialties
has become an important way to address the lack of consensus in the
management of PCOS. Finally, healthcare professionals also report
communication problems with patients. Most clinicians have recognized
6
Patient Education and Counseling 123 (2024) 108197
the importance of lifestyle management, but insufficient time during the
consultation and limited availability of follow-up care hinder their
ability to provide effective support. To address time constraints during
office visits, clinicians can use some strategies to effectively deliver in­
formation about PCOS. These strategies include obtaining the patient’s
medical history in advance, preparing relevant educational materials in
advance, and communicating key aspects of the treatment plan in clear
and concise language. In addition, applying brief intervention to PCOS
health education in clinical practice may address this issue [41].
Previous studies have seldom mentioned the influence of social
environment and culture on PCOS management. Our results showed that
food culture, social life patterns and healthcare system significantly
impact the implementation of PCOS management. Different social food
cultures as well as family food cultures have a huge impact on women to
cook a diet suitable for their condition. For example, the sweet tooth
culture makes it difficult for women with PCOS to follow a low glycemic
index diet. Family attitudes toward food can also greatly affect the di­
etary management of women with PCOS. For young patients, some
parents may reward them with high-calorie foods. Existing studies have
shown that parents of people with PCOS are more likely to have diabetes
than parents of health population, and this may be related to genetics
and family food culture [42]. PCOS management becomes more chal­
lenging by late nights, sedentary lifestyles, and increased societal pres­
sure on women’s roles. We suggest that the government can improve the
public’s understanding of healthy eating and living, especially among
PCOS patients, by strengthening the provision of education on healthy
lifestyles. Additionally, providing propriate mental health education
and psychological counseling can help women better cope with life
stress. Given the high work-related stress in society, we urge the gov­
ernment to offer robust environmental and social support for women,
while also establishing regulations and policies to promote work-life
balance.
4.2. Strengthens and limitation
This thematic synthesis is the first to analyze PCOS management
from a physician’s perspective. Moreover, this study adhered a rigorous
methodology, ensuring that all procedures were thoroughly discussed by
two or more researchers. however, there are some potential limitations.
The study may have missed some relevant information from the gray
literature. Additionally, although the country context of the included
literature included both developed and developing countries, most of
the literature was from Australia, which may influence certain conclu­
sions and restrict the generalizability of the findings.
4.3. Conclusion
This study provides a comprehensive understanding of the chal­
lenges of PCOS management from the perspective of healthcare pro­
fessionals, informing valuable insights to shape future policies and guide
the research directions. The insights gained from this study have the
potential to improve the care of women with PCOS by addressing the
specific barriers and concerns of healthcare professionals.
4.4. Practice implications
Healthcare professionals should consider the needs of women with
PCOS in the process of diagnosis and treatment, and use motivational
interviewing to improve patients’ motivation for PCOS management.
Healthcare managers need to understand the healthcare system barriers
that frontline healthcare workers face in managing PCOS, as well as the
impact of national food cultures and social patterns.
Funding sources
This research did not receive any specific grant from funding
M. Guan et al.
agencies in the public, commercial, or not-for-profit sectors.
CRediT authorship contribution statement
Luo Lan: Writing – original draft, Data curation. He Tan: Writing –
original draft, Methodology, Formal analysis. Wang Binglu: Writing –
original draft, Formal analysis, Data curation. Li Rong: Writing – review
& editing, Writing – original draft, Methodology, Formal analysis, Data
curation, Conceptualization. Zhao Jinxin: Writing – review & editing,
Supervision. Guan Minhui: Writing – review & editing, Writing –
original draft, Methodology, Formal analysis, Data curation, Conceptu­
alization. Lei Jun: Writing – review & editing, Supervision,
Conceptualization.
Declaration of Competing Interest
The authors declare that the research was conducted in the absence
of any commercial or financial relationships that could be construed as a
potential conflict of interest.
Acknowledgements
The authors would like to thank the patient and authors who finish
the initial qualitative study.
Appendix A. Supporting information
Supplementary data associated with this article can be found in the
online version at doi:10.1016/j.pec.2024.108197.
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