Eliciting Low-Risk Thyroid Cancer Treatment Preferences Using Clinical Vignettes: A Pilot Study

ObjectiveWhile surgical resection has been the traditional standard treatment for small (≤1 cm), differentiated thyroid cancers, active surveillance (AS) and radiofrequency ablation (RFA) are increasingly considered. The aim of this study was to explore patient preferences in thyroid cancer treatment using a series of clinical vignettes.MethodsThyroid cancer survivors and general population volunteers were recruited to rank experience-driven clinical vignettes in order of preference. Rankings were compared using Wilcoxon signed rank. Formative qualitative methods were used to develop and refine clinical vignettes that captured 4 treatments—thyroid lobectomy (TL), total thyroidectomy (TT), AS, and RFA—along with 6 treatment complications. Content was validated via interviews with 5 academic subspecialists.ResultsNineteen volunteers participated (10 survivors, 9 general population). Treatment complications were ranked lower than uncomplicated counterparts in 99.0% of cases, indicating excellent comprehension. Counter to our hypothesis, among uncomplicated vignettes, median rankings were 1 for AS, 2 for RFA, 3.5 for TL, and 5 for TT. Trends were consistent between thyroid cancer survivors and the general population. AS was significantly preferred over RFA (P = .02) and TT (P < .01). Among surgical options, TL was significantly preferred over TT (P < .01).ConclusionWhen treatments for low-risk thyroid cancer are described clearly and accurately through clinical vignettes, patients may be more likely to choose less invasive treatment options over traditional surgical resection.     

On the causal relationship between participation in national commemorations and feelings of national belonging

It is often theoretically argued that participation in national commemorations increases feelings of national belonging. Previous studies have also empirically demonstrated that participation in national commemorations and feelings of national belonging are positively related. We are uncertain, however, about the direction of this relationship. Does participating in national commemorations increase feelings of national belonging (increase hypothesis) or do people who attend such ceremonies feel a greater sense of national belonging compared to people who not attend (selection hypothesis)? Using an innovative research design, this study sheds more light on the direction of the relationship between participation in national commemorations and feelings of national belonging. We collected data from respondents before (n?=?469), during (n?=?50) and after (n?=?226) the national ceremony on Remembrance Day in 2015 in the Netherlands. In this study, we found support for the selection hypothesis, but not for the increase hypothesis.     

Factors related to the non-attendance in a clinical oral health study on the home-dwelling old elderly

Objective: To evaluate how elderly home-dwelling subjects’background factors, state of health, functional capacity and edentulousness related to their attendance in a comprehensive clinical dental study. Design: Cross-sectional population study; interview and clinical dental data. Setting: The City of Helsinki; clinical dental examinations at the Institute of Dentistry, University of Helsinki. Subjects: 600 elderly aged 76, 81 and 86 years, participants in the medical examinations in the Helsinki Ageing Study one year earlier, 81% being home-dwelling. Measures : Age, gender, marital status, family structure, educational level, former line of work, self-perceived general health, dentulousness, ability to move, sense of hearing, state of memory, clinical findings of dementia, other medical diagnoses, and intake of drugs. Outcome measure: Participation in clinical dental examinations. Results: The overall participation was 63% being reduced by high age and female gender, 75% of the 76-year-olds, but only 53% of those aged 81 or 86 years were clinically examined, figures were for men 72% and for women 60%. As shown by a multifactorial logit model, the strongest factors related to non-participation were the home-dwelling subjects’old age (OR=3.6), deteriorated ability to move (OR=5.3), clinically diagnosed symptoms of dementia (OR=4.1), or edentulousness (OR=2.5). Conclusion: Non-participation selectively by those edentulous will lead to prevalence figures on numbers of teeth being too optimistic for the entire elderly population.