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E-Patient Counseling Trial (E-PACO): Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy

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Understanding and Addressing Delays in Endocrine Surgery: Insights From a Mixed-Methods Study and a Pilot Educational

Stella Kim¹, Maxwell Foote², Sophia Zhang³

¹Georgetown University School of Medicine, Washington, District of Columbia, USA.

Journal of Surgical Oncology

|July 16, 2026

Summary

Delays in endocrine surgery are mainly due to the referral process, not treatment. A provider education intervention improved primary care providers

Keywords:

communication delays in care education endocrine surgery interoperability referral

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Area of Science:

Endocrine surgery
Healthcare management
Patient outcomes

Background:

Delays in endocrine surgical care lead to negative patient outcomes.
Communication breakdowns are a significant, yet overlooked, factor in these delays.
Understanding multi-level drivers is crucial for improving care.

Purpose of the Study:

Identify multi-level drivers of delay in endocrine surgical care.
Pilot a provider-focused intervention to address referral delays.
Evaluate the impact of the intervention on primary care provider knowledge and confidence.

Main Methods:

Mixed-methods study including retrospective analysis of 898 patients.
Quantified referral and treatment delays, analyzing sociodemographic and system factors.
Conducted semi-structured interviews and a pilot educational intervention for primary care providers (PCPs).

Main Results:

Median referral delay (157 days) was significantly longer than treatment delay (62 days).
Older age, female sex, and thyroid disease were associated with longer referral delays.
The educational intervention enhanced PCP recognition and referral confidence for primary hyperparathyroidism.

Conclusions:

Endocrine surgical delays are multifactorial, involving patient, provider, and system issues.
Provider-focused interventions show promise in mitigating delays.
Further prospective studies are needed to validate the impact on delays and patient outcomes.