Department of Surgery, The University of Alabama at Birmingham, USA.
Department of Surgery, The University of Alabama at Birmingham, USA.
Am J Surg. 2024 Feb;228:122-125. doi: 10.1016/j.amjsurg.2023.08.021. Epub 2023 Aug 23.
The purpose of this study was to qualitatively explore patient-reported barriers to surgery for primary hyperparathyroidism (PHPT) and identify actionable interventions to improve access to surgical care.
We recruited forty-nine patients in an endocrine surgery clinic at a large, academic medical to participate in an 11- question phone interview. All interviewees underwent parathyroidectomy for primary hyperparathyroidism. Responses were recorded and a codebook of qualitative themes, blinded to patient race and sex, was created by 3 independent reviewers. Comments were subsequently sorted into the codebook with patient demographic information.
Patients that experienced delays in parathyroidectomy most commonly cited "issues with the referral process" and "missed diagnosis" as the cause. Patients were asked to identify the most challenging part about the surgery process. Commonly evoked themes among patients of both races and sexes included "transportation" and "financial" with subthemes of "no ride," "distance from surgeon," "insurance," and "difficulty taking time off work." Patients were asked to name actionable interventions to improve access to surgical care. The most commonly evoked theme involved "support systems," with subthemes of "transportation assistance," "financial," and "patient advocacy." Physician factors were also commonly evoked among patients of both races with subthemes of "knowledge", "communication," and "listening."
PHPT patients cited multiple barriers to undergoing surgery. Future work can focus on examining these questions with a larger patient cohort and examining delays at the referral and diagnosis stage, which was most commonly cited by our respondents.
本研究旨在定性探讨原发性甲状旁腺功能亢进症（PHPT）患者手术的障碍，并确定可采取的干预措施以改善手术护理的获取途径。
我们在一家大型学术医学内分泌外科诊所招募了 49 名患者参与 11 个问题的电话访谈。所有接受访谈的患者均因原发性甲状旁腺功能亢进症接受甲状旁腺切除术。记录受访者的回答，并由 3 位独立的评论者创建一个针对定性主题的编码本，该编码本不考虑患者的种族和性别。随后，将评论按照编码本和患者的人口统计学信息进行分类。
经历甲状旁腺切除术延迟的患者最常将“转诊过程中的问题”和“漏诊”列为原因。我们要求患者指出手术过程中最具挑战性的部分。不同种族和性别的患者普遍提到的主题包括“交通”和“财务”，以及“没有车接送”、“与外科医生的距离”、“保险”和“难以请假”等子主题。患者被要求提出改善手术护理获取途径的可采取的干预措施。最常被提及的主题涉及“支持系统”，其中包括“交通援助”、“财务”和“患者权益倡导”。不同种族的患者也普遍提到医生的因素，包括“知识”、“沟通”和“倾听”等子主题。
PHPT 患者列举了接受手术的多个障碍。未来的研究可以重点关注对更大的患者群体进行这些问题的研究，并研究转诊和诊断阶段的延迟，这是我们受访者最常提到的。
