title: Is chronic pelvic pain a comfortable diagnosis for primary care practitioners: a qualitative study.
abstract: BACKGROUND
  Chronic pelvic pain (CPP) has a prevalence similar to asthma and chronic back pain, but little is known about how general practitioners (GPs) and practice nurses manage women with this problem. A clearer understanding of current management is necessary to develop appropriate strategies, in keeping with current health care policy, for the supported self-management of patients with long term conditions. The aim of this study was to explore GPs' and practice nurses' understanding and perspectives on the management of chronic pelvic pain.
  
  
  METHODS
  Data were collected using semi-structured interviews with a purposive sample of 21 GPs and 20 practice nurses, in three primary care trusts in the North West of England. Data were analysed using the principles of Framework analysis.
  
  
  RESULTS
  Analysis suggests that women who present with CPP pose a challenge to GPs and practice nurses. CPP is not necessarily recognized as a diagnostic label and making the diagnosis was achieved only by exclusion. This contrasts with the relative acceptability of labels such as irritable bowel syndrome (IBS). GPs expressed elements of therapeutic nihilism about the condition. Despite practice nurses taking on increasing responsibilities for the management of patients with long term conditions, respondents did not feel that CPP was an area that they were comfortable in managing.
  
  
  CONCLUSIONS
  The study demonstrates an educational/training need for both GPs and practice nurses. GPs described a number of skills and clinical competencies which could be harnessed to develop a more targeted management strategy. There is potential to develop facilitated self- management for use in this patient group, given that this approach has been successful in patients with similar conditions such as IBS.
authors.affiliation: School of Nursing, Midwifery and Social Work, University of Manchester, UK. linda.mcgowan@manchester.ac.uk
authors.forename: Linda
authors.initials: L
authors.lastname: McGowan
authors.forename: Diane
authors.initials: D
authors.lastname: Escott
authors.forename: Karen
authors.initials: K
authors.lastname: Luker
authors.forename: Francis
authors.initials: F
authors.lastname: Creed
authors.forename: Carolyn
authors.initials: C
authors.lastname: Chew-Graham
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002908:Chronic Disease; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008134:Long-Term Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000193:education / Q000523:psychology; D010346:Patient Care Management / Q000379:methods; D017699:Pelvic Pain / Q000175:diagnosis* / Q000523:psychology; D010821:Physicians, Family / Q000193:education / Q000523:psychology*; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D036301:Qualitative Research; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012648:Self Care; D016387:Women's Health