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The following is a summary of “Thresholds for surgical referral in primary hyperparathyroidism: A conjoint analysis,” published in the November 2023 issue of Surgery by Wu, et al.
Primary hyperparathyroidism (PHPT) is a curable condition through surgery, but the decision to refer for treatment often depends on the individual provider. Understanding the factors influencing referral choices is crucial for optimizing patient care. For a study, researchers sought to employ a conjoint analysis to identify the key determinants influencing the decision to refer PHPT patients for surgery.
An online survey was conducted involving endocrinologists and other physicians. Participants were presented with 10 patient scenarios, incorporating various clinical factors (such as age and comorbidities) and biochemical factors (mild or classic disease). Based on these factors, they were then asked to decide whether to refer the patient for surgery or medical management.
The likelihood of surgery referral significantly increased when the patient exhibited classic PHPT, was below 50, had no comorbidities, presented with osteoporosis, and was under the care of a surgical provider (P < 0.001). Notably, physician characteristics such as gender, practice duration, and setting did not significantly influence the decision-making process.
The study revealed that, despite the documented benefits of surgery, non-surgical physicians were less inclined to refer PHPT patients for surgical treatment, particularly when patients were older (age ≥ 50), had comorbid conditions, or demonstrated mild disease. The findings underscored the need for increased education and advocacy to enhance access to surgery for PHPT patients.
Source: americanjournalofsurgery.com/article/S0002-9610(23)00324-0/fulltext
