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Published on: July 14, 2023
Why patients decline parathyroidectomy: A mixed-methods analysis of decision-making in primary hyperparathyroidism
Alexandra Helbing1, Diana Gutierrez-Meza2, Esra Alagoz2
1University of Wisconsin - Madison, School of Medicine and Public Health, Department of Surgery, 600 Highland Avenue, Madison, WI, 53792-7375, USA; Parkview Health, Department of Surgery, Fort Wayne, IN, 46805-4638, USA.
Introduction:
Less than one-third of patients diagnosed with primary hyperparathyroidism (PHPT) undergo parathyroidectomy. While disparities in referral have been well described, patient perspectives after endocrine surgery referral remain poorly understood.
Methods:
We performed a mixed-methods study within a single academic health system, integrating qualitative patient interviews and chart review. Adults diagnosed with PHPT between 2021 and 2025 were identified, and those who did not undergo surgery were invited for a semi-structured interview to explore their decision-making.
Results:
Among 14,512 patients with PHPT, 5481 (37.7%) underwent parathyroidectomy. Of the 9031 patients who did not undergo surgery, only 1130 (12.5%) had a documented referral to endocrine surgery. Qualitative deductive-inductive analysis of 13 interviews identified three major themes: low perceived urgency of the disease, hesitance toward surgery, and competing health and life priorities.
Conclusions:
Among patients referred to endocrine surgery, modifiable barriers to parathyroidectomy centered on disease understanding, surgical hesitancy, and competing priorities. These findings may inform interventions to improve progression to definitive surgical care.
