Physician Communication, Repeated Healthcare Encounters, and Diagnostic Delay in Endometriosis: An Exploratory
Cristina-Elena Mandici1, Daniela Roxana Matasariu1,2, Irina Draga Căruntu1,3
1Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania.
Background:
Endometriosis is often diagnosed years after symptom onset, while communication-related factors remain poorly defined in Central and Eastern Europe.
Methods:
In this cross-sectional study, 150 Romanian women reporting surgically confirmed endometriosis completed an online questionnaire on diagnostic history and patient-physician communication, assessed with a seven-item Likert scale (Cronbach's α = 0.836).
Results:
Mean diagnostic delay was 9.1 years (median 8; IQR 4-13), with 5.2 physicians and 10.2 consultations before diagnosis. Delay was unrelated to symptom severity (r = 0.07, p = 0.43) but inversely related to age at symptom onset (r = -0.68). Adolescent-onset symptoms were followed by a 14.9-year delay versus 5.8 years for adult-onset symptoms. In multivariable analysis (adjusted R2 = 0.49), earlier onset and more consultations remained independently associated with delay. Communication had an indirect association through consultation number (effect -0.68; 95% bootstrap CI -1.26 to -0.22), accounting for 38% of the total association; direction cannot be inferred from cross-sectional data. Symptom minimization (76%) was linked to more physicians and longer delays (10.0 vs. 6.0 years; d = 0.60).
Conclusions:
Earlier onset and repeated healthcare encounters were related to delay than symptom severity. The self-selected, urban, highly educated sample limits generalizability and causal interpretation.