A Prospective Mixed-Methods Study of Decision-Making on Surgery or Active Surveillance for Low-Risk Papillary Thyroid Cancer
Open Access
- 1 July 2020
- journal article
- research article
- Published by Mary Ann Liebert Inc in Thyroid®
- Vol. 30 (7), 999-1007
- https://doi.org/10.1089/thy.2019.0592
Abstract
Background: 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. Methods: 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 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. Conclusions: 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.Keywords
This publication has 21 references indexed in Scilit:
- 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid CancerThyroid®, 2016
- Incidences of Unfavorable Events in the Management of Low-Risk Papillary Microcarcinoma of the Thyroid by Active Surveillance Versus Immediate SurgeryThyroid®, 2016
- Incidence of differentiated thyroid cancer in Canada by City of residenceJournal of Otolaryngology - Head & Neck Surgery, 2015
- Patient Age Is Significantly Related to the Progression of Papillary Microcarcinoma of the Thyroid Under ObservationThyroid®, 2014
- Predictors of satisfaction with treatment decision, decision-making preferences, and main treatment goals in patients with advanced cancerSupportive Care in Cancer, 2013
- Increased incidence of differentiated thyroid carcinoma and detection of subclinical diseaseCMAJ : Canadian Medical Association Journal, 2007
- Comparing Telephone and Face-to-Face Qualitative Interviewing: a Research NoteQualitative Research, 2004
- Reframing the evaluation of qualitative health research: reflections on a review of appraisal guidelines in the health sciencesJournal of Evaluation in Clinical Practice, 2003
- Patient Satisfaction with Health Care DecisionsMedical Decision Making, 1996
- Validation of client decision-making instruments in the context of psychiatry.1996