Eliciting Low-Risk Thyroid Cancer Treatment Preferences Using Clinical Vignettes: A Pilot Study |
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| Institution: | 1. Department of Surgery, University of Maryland, Baltimore, Baltimore, Maryland;2. Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, Maryland;3. Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland;4. Department of Family Medicine, University of Maryland Baltimore, Baltimore, Maryland;1. Mayo Clinic Department of Medicine, Division of Endocrinology, Diabetes, Nutrition Rochester, Minnesota;2. Midwest Endocrinology, Crystal Lake, Illinois;3. Mayo Clinic Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Jacksonville, Florida;1. Endocrinology and Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México;2. Clinical Epidemiology Unit, Hospital Infantil Federico Gómez, Mexico City, México;3. Clinical Epidemiology Unit, UMAE, Hospital de Especialidades Centro Medico Siglo XXI, IMSS, Mexico City, México;4. Metabolic Diseases Research Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México;1. Nursing Department, Universitat Rovira Virgili, Campus Terres de l’Ebre, Avenue Remolins, Tarragona, Spain;2. Department of Health and Medical Science, Liwa College of Technology, Abu Dhabi, United Arab Emirates;3. Hospital de Tortosa Verge de la Cinta, Catalan Institute of Health, Pere Virgili Institute, Carretera Esplanetes, Tarragona, Spain;1. Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey;2. Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey;3. PROUD Gender Center of New Jersey, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey;4. Division of Pediatric Endocrinology, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey;1. Department of Internal Medicine, Division of Endocrinology, American University of Beirut, Beirut, Lebanon;2. Department of Endocrinology, Diabetology and Nutrition, Reference Centre for Rare Pituitary Diseases HYPO, Ambroise-Paré University Hospital, AP–HP, 92100 Boulogne-Billancourt, France;3. EA4340, UFR des sciences de la santé Simone-Veil, université de Versailles Saint-Quentin-en-Yvelines, 78423 Montigny-le-Bretonneux, France;4. Department of Neurosurgery, La Pitié Salpétrière University Hospital, AP–HP, 75013 Paris, France;1. Department of Pathology, Houston Methodist Hospital, Houston, Texas;2. Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio;3. Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois;4. Endocrinology and Metabolism Institute, Cleveland Clinic Foundation, Cleveland, Ohio |
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| Abstract: | 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. |
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| Keywords: | thyroid neoplasms clinical decision making stakeholder participation radiofrequency ablation thyroidectomy patient preference AS"} {"#name":"keyword" "$":{"id":"kwrda0b040"} "$$":[{"#name":"text" "_":"active surveillance PTMC"} {"#name":"keyword" "$":{"id":"kwrdda0040"} "$$":[{"#name":"text" "_":"papillary thyroid microcarcinoma RFA"} {"#name":"keyword" "$":{"id":"kwrda00hh40"} "$$":[{"#name":"text" "_":"radiofrequency ablation TL"} {"#name":"keyword" "$":{"id":"kwrda0j040"} "$$":[{"#name":"text" "_":"thyroid lobectomy TT"} {"#name":"keyword" "$":{"id":"ktttywrda0040"} "$$":[{"#name":"text" "_":"total thyroidectomy |
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