Integrating Digital Screening and Co-designed Pathways Improves Psychosocial Care, Patient Satisfaction, and Guideline Adherence in Polycystic Ovary Syndrome

Background: Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine conditions in women, affecting over 10% of women worldwide. It is associated with significant reproductive, metabolic, and psychosocial burdens. In the UK, management remains fragmented, with limited coordination between primary and secondary care, time-constrained consultations, and inconsistent assessment of mental, reproductive, and physical health needs. Addressing these gaps requires an integrated, patient-centred approach that embeds psychosocial assessment and education within routine care.

 

Approach: We developed PCOS SEva (Service Evaluation)—a digitally enabled, co-designed care model that standardises holistic PCOS consultations across NHS sites. The model integrates pre- and post-consultation digital surveys assessing anxiety/depression using the Hospital Anxiety and Depression Scale (HADS), body image using the Body Image Concern Inventory (BICI), sexual function using the Female Sexual Function Index (FSFI), quality of life using PCOS quality of Life survey (PCOSQoL), and hirsutism using modified Ferriman Galway Score (mFG), alongside post-consultation satisfaction and experience measures. The post-consultation survey included links to various educational resources.

 

Clinical pathways for common PCOS presentations were co-designed with patients, endocrinologists, gynaecologists, general practitioners, and nurses. Multilingual, evidence-based patient resources—including educational videos on lifestyle management and common medications—were developed collaboratively with women with lived experience to address literacy and further translated to multiple languages to address language barriers.

 

A mixed-methods Type 2 hybrid implementation–effectiveness study is being conducted from April 2025 to June 2026 at three NHS centres, using the Implementation Research Logic Model (IRLM) and Non-adoption, Abandonment, Scale-up, Spread, Sustainability complexity assessment toolkit (NASSS-CAT) frameworks. These guided evaluations of contextual complexity, adoption, and fidelity. Implementation strategies, informed by ERIC, included clinician training, audit and feedback, and integration of PCOS SEva pathways into local clinical guidelines. Semi-structured interviews with ~10 stakeholders at each phase (baseline, interim, and follow-up) will be thematically analysed using Braun and Clarke’s approach.

 

Results: To date, 33 women have completed pre-consultation surveys and 25 post-consultation surveys. Median age was 30 years, and median BMI 34.3 kg/m². Delays to diagnosis were common, with a median time of 18 months from first healthcare contact. Over 60% of respondents reported receiving little or no information on fertility or long-term complications at diagnosis. High levels of psychological distress were observed (48% moderate–severe anxiety; 39% mild–moderate depression), and >70% reported significant body image concerns.

Following the PCOS SEva consultation, 96% rated their experience as “good” or “very good,” 84% felt actively involved in decision-making, and 88% were likely or very likely to recommend the clinic to others. Interviews highlighted improved clinician awareness of psychosocial needs, enhanced patient engagement, and seamless integration of digital tools into workflows.

 

Implications: PCOS SEva demonstrates the feasibility and acceptability of embedding holistic, digitally supported care within routine clinical practice. Early findings suggest an improved patient experience and increased provider engagement, with potential for scalability across diverse NHS settings. This co-designed model aligns with 2023 international PCOS care recommendations and offers a transferable framework for integrating psychosocial care into PCOS management.