{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T02:21:35Z","timestamp":1790734895504,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Objectives<\/jats:title>\n                    <jats:p>Delays in endocrine surgical care contribute to adverse events, patient dissatisfaction, and mortality. Communication is an overlooked contributor. This study identified multi\u2010level drivers of delay and piloted a provider\u2010focused intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted an IRB\u2010approved mixed\u2010methods study. A retrospective analysis of 898 patients who underwent thyroid, parathyroid, and adrenal surgery at a single academic center between January 2023 and August 2024 quantified referral (first abnormal lab or imaging to first surgical consultation) and treatment (consultation to surgery) delays, evaluating sociodemographic, patient portal, and interoperability factors. Semi\u2010structured interviews with patients and staff explored patient\u2010, provider\u2010, and system\u2010level barriers. A pilot educational intervention for primary care providers (PCPs) assessed pre\u2010post changes in referral\u2010related knowledge and comfort caring for primary hyperparathyroidism.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Median referral delay (157 days) exceeded treatment delay (62 days), suggesting delays occurred primarily during the referral phase of care. Older age, female sex, and thyroid disease independently predicted longer referral delays. Our educational intervention improved PCP recognition and referral confidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Delays in endocrine surgical care are multifactorial, spanning patient\u2010, provider\u2010, and system\u2010level factors. Provider\u2010focused interventions are promising, but prospective studies are needed to confirm impact on delays and outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jso.70341","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T09:36:37Z","timestamp":1784194597000},"page":"702-709","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Understanding and Addressing Delays in Endocrine Surgery: Insights From a Mixed\u2010Methods Study and a Pilot Educational Intervention"],"prefix":"10.1002","volume":"134","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-9420-1739","authenticated-orcid":false,"given":"Stella","family":"Kim","sequence":"first","affiliation":[{"name":"Georgetown University School of Medicine Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxwell","family":"Foote","sequence":"additional","affiliation":[{"name":"Department of Endocrine Surgery MedStar Washington Hospital Center Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Zhang","sequence":"additional","affiliation":[{"name":"Georgetown University Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Audrey","family":"Twyford","sequence":"additional","affiliation":[{"name":"Georgetown University Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abigail","family":"Fox","sequence":"additional","affiliation":[{"name":"Georgetown University School of Medicine Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1030-0811","authenticated-orcid":false,"given":"Jennifer E.","family":"Rosen","sequence":"additional","affiliation":[{"name":"Department of Endocrine Surgery MedStar Washington Hospital Center Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"issue":"4","key":"e_1_2_8_2_1","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1016\/j.amjsurg.2021.07.009","article-title":"Impact of the COVID\u201019 Pandemic on the Practice of Endocrine Surgery","volume":"223","author":"Beninato T.","year":"2022","journal-title":"American Journal of Surgery"},{"issue":"1","key":"e_1_2_8_3_1","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.surg.2022.06.043","article-title":"Limited Disease Progression in Endocrine Surgery Patients With Treatment Delays Due to COVID\u201019","volume":"173","author":"Collins R. A.","year":"2023","journal-title":"Surgery"},{"issue":"10","key":"e_1_2_8_4_1","doi-asserted-by":"crossref","first-page":"2589","DOI":"10.1210\/clinem\/dgad163","article-title":"Delay in Surgery and Papillary Thyroid Cancer Survival in the United States: A SEER\u2010Medicare Analysis","volume":"108","author":"Chaves N.","year":"2023","journal-title":"Journal of Clinical Endocrinology & Metabolism"},{"issue":"2","key":"e_1_2_8_5_1","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1097\/SLA.0000000000006508","article-title":"Effect of Delayed Parathyroidectomy on Risk of Future Cardiovascular and Nephrolithiasis Interventions in Adults With Primary Hyperparathyroidism","volume":"283","author":"Ramonell K. M.","year":"2026","journal-title":"Annals of Surgery"},{"issue":"4","key":"e_1_2_8_6_1","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1016\/j.surg.2024.06.026","article-title":"Understanding Delays to Parathyroidectomy: A Mixed\u2010Methods Approach","volume":"176","author":"Chen C.","year":"2024","journal-title":"Surgery"},{"issue":"6","key":"e_1_2_8_7_1","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1089\/thy.2022.0723","article-title":"Inequities in Thyroid Cancer Care: Populations Most at Risk for Delays in Diagnosis and Treatment","volume":"33","author":"Lopez B.","year":"2023","journal-title":"Thyroid"},{"key":"e_1_2_8_8_1","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.jss.2022.02.049","article-title":"Missed Opportunities to Promptly Diagnose and Treat Adrenal Tumors","volume":"276","author":"Makris K. I.","year":"2022","journal-title":"Journal of Surgical Research"},{"issue":"5","key":"e_1_2_8_9_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2024-085312","article-title":"How Does Communication Affect Patient Safety? Protocol for a Systematic Review and Logic Model","volume":"14","author":"Howick J.","year":"2024","journal-title":"BMJ Open"},{"issue":"4","key":"e_1_2_8_10_1","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1093\/jamia\/ocaa003","article-title":"Hospital Adoption of Multiple Health Information Exchange Approaches and Information Accessibility","volume":"27","author":"Everson J.","year":"2020","journal-title":"Journal of the American Medical Informatics Association"},{"issue":"5","key":"e_1_2_8_11_1","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1016\/j.surg.2020.11.019","article-title":"Patient Experience With Electronic Health Record\u2010Integrated Postoperative Telemedicine Visits in an Academic Endocrine Surgery Program","volume":"169","author":"Schumm M. A.","year":"2021","journal-title":"Surgery"},{"key":"e_1_2_8_12_1","unstructured":"Chesapeake Regional Information System for our Patients (CRISP). CRISP Website [Internet]. Columbia (MD): CRISP; c2025 [cited2026Apr 4].https:\/\/www.crisphealth.org\/."},{"key":"e_1_2_8_13_1","volume-title":"CommonWell Health Alliance Website [Internet]","author":"CommonWell Health Alliance","year":"2025"},{"issue":"3","key":"e_1_2_8_14_1","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1093\/jamia\/ocad250","article-title":"Do Patients Who Read Visit Notes on the Patient Portal Have a Higher Rate of \u201cLoop Closure\u201d on Diagnostic Tests and Referrals in Primary Care? A Retrospective Cohort Study","volume":"31","author":"Bell S. K.","year":"2024","journal-title":"Journal of the American Medical Informatics Association"},{"issue":"4","key":"e_1_2_8_15_1","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1001\/jamasurg.2020.6175","article-title":"Patient Factors Associated With Parathyroidectomy in Older Adults With Primary Hyperparathyroidism","volume":"156","author":"Seib C. D.","year":"2021","journal-title":"JAMA Surgery"},{"issue":"8","key":"e_1_2_8_16_1","doi-asserted-by":"crossref","first-page":"2114","DOI":"10.1002\/hed.70232","article-title":"Socioeconomic Health Disparities in the Treatment of Thyroid Cancer: A Single Institution in Southwestern Ohio","volume":"48","author":"Dominguez B.","year":"2026","journal-title":"Head & Neck"},{"issue":"4","key":"e_1_2_8_17_1","doi-asserted-by":"crossref","first-page":"e1336","DOI":"10.1210\/clinem\/dgad519","article-title":"Racial and Ethnic Disparities in the Diagnosis and Treatment of Thyroid Disease","volume":"109","author":"Gillis A.","year":"2024","journal-title":"Journal of Clinical Endocrinology & Metabolism"},{"issue":"9","key":"e_1_2_8_18_1","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1001\/jama.2018.0898","article-title":"The Diagnosis and Management of Thyroid Nodules: A Review","volume":"319","author":"Durante C.","year":"2018","journal-title":"Journal of the American Medical Association"},{"issue":"5","key":"e_1_2_8_19_1","doi-asserted-by":"crossref","DOI":"10.1002\/hsr2.70785","article-title":"General Practitioners\u2019 Perspectives on Barriers to Communication With Specialists in the Referral System: A Systematic Review and Meta\u2010Synthesis","volume":"8","author":"Fattahi H.","year":"2025","journal-title":"Health Science Reports"},{"issue":"9","key":"e_1_2_8_20_1","doi-asserted-by":"crossref","first-page":"e828","DOI":"10.1634\/theoncologist.2018-0424","article-title":"Failure to Diagnose and Treat Hyperparathyroidism Among Patients With Hypercalcemia: Opportunities for Intervention at the Patient and Physician Level to Increase Surgical Referral","volume":"24","author":"Asban A.","year":"2019","journal-title":"Oncologist"},{"key":"e_1_2_8_21_1","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.amjsurg.2023.08.021","article-title":"Patient Perspectives on Barriers to Obtaining Surgery for Primary Hyperparathyroidism: A Qualitative Review","volume":"228","author":"Phillips W.","year":"2024","journal-title":"American Journal of Surgery"},{"issue":"5","key":"e_1_2_8_22_1","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1001\/archpedi.154.5.499","article-title":"Coordination of Specialty Referrals and Physician Satisfaction With Referral Care","volume":"154","author":"Forrest C. B.","year":"2000","journal-title":"Archives of Pediatrics & Adolescent Medicine"},{"issue":"3","key":"e_1_2_8_23_1","doi-asserted-by":"crossref","DOI":"10.2196\/13354","article-title":"Improving the Referral Process, Timeliness, Effectiveness, and Equity of Access to Specialist Medical Services Through Electronic Consultation: Pilot Study","volume":"7","author":"Nabelsi V.","year":"2019","journal-title":"JMIR Medical Informatics"},{"issue":"1","key":"e_1_2_8_24_1","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1038\/s41746-025-01586-2","article-title":"Opportunities and Risks of Artificial Intelligence in Patient Portal Messaging in Primary Care","volume":"8","author":"Biro J. 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