The Department of Obstetrics and Gynecology at Rowan University School of Osteopathic Medicine proposes to engage 225 women with opiate use disorders from underserved communities of New Jersey in an Endometriosis Education, Screening, Brief Intervention, and Referral to Treatment (ENDO-SBIRT) intervention to rapidly identify women at risk for endometriosis, link them to diagnosis and treatment, and decrease fatal overdose.
Endometriosis affects approximately 10% of women worldwide. The condition is defined by the presence of endometrial-like tissue outside the uterine cavity. It is responsible for severe pain and infertility and has a major impact on quality of life. The delay between the onset of symptoms and diagnosis of endometriosis is typically between 6 and 10 years. While endometriosis is not fatal, women with undiagnosed endometriosis may turn to illicit opiates to relieve pain, placing them at risk for overdose. A study of commercial claims data from 2009 to 2018 of 61,019 women with endometriosis found that 37.9% had high-risk or chronic opiate use conditions. There is increasing evidence of the link between chronic pelvic pain due to unaddressed endometriosis and the transition from prescription opioids to illicit opiate use.
While advances in laparoscopic surgery and gynecological imaging have increased the ability of physicians to diagnose and treat endometriosis, referring all patients suspected of having endometriosis to laparoscopic surgeons and specialized radiologists is not feasible. Researchers have developed a patient questionnaire to detect patients at high risk for endometriosis as the first step in the diagnostic process. However, the screening tool has never been implemented in a public health model to address diagnostic delays. Given the opiate overdose public health crisis, there is a need to rapidly identify high-risk women who may be using illicit opiates to alleviate undiagnosed endometriosis-related pain. The long-term goal of this project is to develop a public health model that includes a validated questionnaire to rapidly identify women in early recovery from opiate use disorders at risk for endometriosis, link them to diagnosis and treatment, and ultimately decrease endometriosis-related fatal overdose.
The project will develop an Endometriosis Education, Screening, Brief Intervention, and Referral to Treatment (ENDO-SBIRT) Intervention that will be delivered individually to women over 15-20 minutes. ENDO-SBIRT will include: 1) a 10-minute educational module on endometriosis, 2) screening for endometriosis risk using the Chapron Patient Questionnaire, 3) discussion of the results of the screening during a brief intervention, and 4) referral of women assessed to be at high or very high risk for endometriosis to a provider for further evaluation, diagnosis, and treatment. A trained community health worker will deliver the intervention under the supervision of an OB/GYN physician. A partnership with three substance use treatment providers will engage 225 women in the intervention over three years.
The geographic catchment area will be five counties in southern New Jersey with the highest overdose rates, including Atlantic, Camden, Burlington, Gloucester, and Ocean Counties. The population of focus will be women of reproductive age who use illicit opiates to relieve the pain of undiagnosed endometriosis. Outcomes that will be measured include the number of women assessed to be at high risk for endometriosis, the number of women diagnosed with and treated for endometriosis, and changes in endometriosis knowledge and quality of life. The goals are to 1) Implement and evaluate the ENDO-SBIRT intervention, 2) Identify and track evidence-based outcomes, and 3) Transition ENDO-SBIRT to sustainability. Disparities will be monitored using a continuous quality improvement approach. A process and outcome evaluation are planned for the project.