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Publications

Journal Article Research Support, Non-U.S. Gov't Ppublish 66 citations

PubMed: 32126932 DOI: 10.1089/thy.2019.0592

A Prospective Mixed-Methods Study of Decision-Making on Surgery or Active Surveillance for Low-Risk Papillary Thyroid Cancer.

Thyroid 30(7):999-1007

Authors: Anna M Sawka, Sangeet Ghai, Tom Yoannidis, Lorne Rotstein, Patrick J Gullane, Ralph W Gilbert, Jesse D Pasternak, Dale H Brown, Antoine Eskander, John R de Almeida, Jonathan C Irish, Kevin Higgins, Danny J Enepekides, Eric Monteiro, Avik Banerjee, Manish Shah, Everton Gooden, Afshan Zahedi, Mark Korman, Shereen Ezzat, Jennifer M Jones, Valeria E Rac, George Tomlinson, Aleksandra Stanimirovic, Amiram Gafni, Nancy N Baxter, David P Goldstein

Affiliations

  • Division of Endocrinology, University Health Network and University of Toronto, Toronto, Canada.
  • Joint Department of Medical Imaging, University Health Network-Mt Sinai Hospital-Women's College Hospital, University of Toronto, Toronto, Canada.
  • Department of Otolaryngology-Head and Neck Surgery, University Health Network, Toronto, Canada.
  • Department of Surgery, University Health Network and University of Toronto, Toronto, Canada.
  • Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada.
  • Department of Otolaryngology and Head and Neck Surgery, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada.
  • Department of Otolaryngology and Head and Neck Surgery, Mount Sinai Hospital and University of Toronto, Toronto, Canada.
  • Department of Otolaryngology and Head and Neck Surgery, Grand River Hospital Corporation, Kitchener, Canada.
  • Department of Otolaryngology and Head and Neck Surgery, North York General Hospital and University of Toronto, Toronto, Canada.
  • Division of Endocrinology, Women's College Hospital, Mount Sinai Hospital and University of Toronto, Toronto, Canada.
  • Department of Otolaryngology and Head and Neck Surgery, William Osler Health System and University of Toronto, Brampton, Canada.
  • Division of Endocrine Oncology, Princess Margaret Cancer Centre, Toronto, Canada.
  • Department of Psychosocial Oncology, University Health Network and University of Toronto, Toronto, Canada.
  • Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute (TGHRI), University Health Network (UHN), Toronto, Canada.
  • Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
  • Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, Canada.
  • Department of Medicine University Health Network and Mount Sinai Hospital and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
  • Department of Health Research Methods, Evaluation and Implementation, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada.
  • Department of Surgery, St. Michael's Hospital and University of Toronto, Toronto, Canada.

Abstract

Active surveillance (AS) of small, low-risk papillary thyroid cancers (PTCs) is increasingly being considered. There is limited understanding of why individuals with low-risk PTC may choose AS over traditional surgical management. We present a mixed-methods analysis of a prospective observational real-life decision-making study regarding the choice of thyroidectomy or AS for management of localized, low-risk PTCs <2 cm in maximum diameter (NCT03271892). Patients were provided standardized medical information and were interviewed after making their decision (which dictated disease management). We evaluated patients' levels of decision-self efficacy (confidence in medical decision-making ability) at the time information was presented and their level of decision satisfaction after finalizing their decision (using standardized questionnaires). We asked patients to explain the reason for their choice and qualitatively analyzed the results. We enrolled 74 women and 26 men of mean age 52.4 years, with a mean PTC size of 11.0 mm (interquartile range 9.0, 14.0 mm). Seventy-one patients (71.0% [95% confidence interval 60.9-79.4%]) chose AS over surgery. Ninety-four percent (94/100) of participants independently made their own disease management choice; the rest shared the decision with their physician. Participants had a high baseline level of decision self-efficacy (mean 94.3, standard deviation 9.6 on a 100-point scale). Almost all (98%, 98/100) participants reported high decision satisfaction. Factors reported by patients as influencing their decision included the following: perceived risk of thyroidectomy or the cancer, family considerations, treatment timing in the context of life circumstances, and trust in health care providers. In this Canadian study, ∼7 out of 10 patients with small, low-risk PTC, who were offered the choice of AS or surgery, chose AS. Personal perceptions about cancer or thyroidectomy, contextual factors, family considerations, and trust in health care providers strongly influenced patients' disease management choices.

MeSH

Trust, Thyroid Cancer, Papillary, Disease Management, Thyroid Diseases, Neoplasms, Thyroid Gland, Decision Making, Health Personnel, Thyroid Neoplasms, Thyroidectomy, Thyroid Hormones

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