Physician Communication, Repeated Healthcare Encounters, and Diagnostic Delay in Endometriosis: An Exploratory Cross-Sectional Analysis

Cristina Elena Mandici, Daniela Roxana Matasariu, Irina-Draga Căruntu, Bogdan Doroftei, Dimitriu C, Liliana-Claudia Strat, Lucian Vasile Boiculese, Alexandra Ursache, Bujor IE, Ioana Adriana Popescu, Mihaela Grigore
In: Healthcare · 2026 · vol. 14(19) , pp. 3237 · doi:10.3390/healthcare14193237 · W7215056068
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This cross-sectional study of Romanian women with surgically confirmed endometriosis found that diagnostic delay was associated with earlier symptom onset and repeated healthcare encounters rather than symptom severity.

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Abstract

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.

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