Brooke Nickel1,2, Juan P Brito3, Alexandra Barratt1, Susan Jordan4,5, Ray Moynihan1,6, Kirsten McCaffery1,2. 1. 1 Wiser Healthcare, Sydney School of Public Health, The University of Sydney , Sydney, Australia . 2. 2 Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney , Sydney, Australia . 3. 3 Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Rochester, Mayo Clinic , Minnesota. 4. 4 QIMR Berghofer Medical Research Institute , Brisbane, Australia . 5. 5 School of Public Health, The University of Queensland , St. Lucia, Australia . 6. 6 Centre for Research in Evidence-Based Practice, Bond University , Robina, Australia .
Abstract
BACKGROUND: There is growing acceptance that the increase in thyroid cancer incidence is in part a result of overdiagnosis of small low-risk papillary microcarcinomas (PMCs) with indolent clinical course. Although surgery is the cornerstone treatment for patients with PMCs, recent management guidelines are shifting toward inclusion of more conservative treatments such as active surveillance. There is little evidence on clinicians' experience in managing PMC patients and their attitudes toward treatment options, including their willingness to accept a nonsurgical option. The aim of this study was to understand how clinicians perceive a diagnosis of PMC, potential changes to terminology, and the treatment options available to patients. METHODS: This was a qualitative study using semi-structured interviews conducted between November 2015 and May 2016 with 22 clinicians (seven endocrinologists and 15 thyroid surgeons). Transcribed audio-recordings were thematically coded, and a framework method was used to analyze the data. RESULTS: Across a sample of clinicians who manage thyroid cancer patients, awareness of overdiagnosis and overtreatment of PMC was common. However, there was little acceptance of active surveillance to manage these patients. Clinicians did not feel comfortable recommending this management approach, as they were worried about the risk of metastases, did not feel that evidence to support this approach was strong enough, and also believed that patients currently have a high preference for surgery. The majority of clinicians did not believe that changing the terminology of this diagnosis was a viable strategy to reduce patients' anxiety and their perceived preference for more aggressive treatments. However, most clinicians felt that thyroid nodules <1 cm should not be biopsied, which could help minimize the risk of overdiagnosis of PMC. CONCLUSIONS: This study, based on a non-representative sample of 22 clinicians, which remains an important limitation, provides revealing insight into clinicians' management preferences and decision making for small low-risk thyroid cancers at a time when management guidelines and practices are evolving. It suggests that clinicians may not be ready to accept nonsurgical options, or changes in terminology, until evidence to support these options and changes is stronger.
BACKGROUND: There is growing acceptance that the increase in thyroid cancer incidence is in part a result of overdiagnosis of small low-risk papillary microcarcinomas (PMCs) with indolent clinical course. Although surgery is the cornerstone treatment for patients with PMCs, recent management guidelines are shifting toward inclusion of more conservative treatments such as active surveillance. There is little evidence on clinicians' experience in managing PMC patients and their attitudes toward treatment options, including their willingness to accept a nonsurgical option. The aim of this study was to understand how clinicians perceive a diagnosis of PMC, potential changes to terminology, and the treatment options available to patients. METHODS: This was a qualitative study using semi-structured interviews conducted between November 2015 and May 2016 with 22 clinicians (seven endocrinologists and 15 thyroid surgeons). Transcribed audio-recordings were thematically coded, and a framework method was used to analyze the data. RESULTS: Across a sample of clinicians who manage thyroid cancerpatients, awareness of overdiagnosis and overtreatment of PMC was common. However, there was little acceptance of active surveillance to manage these patients. Clinicians did not feel comfortable recommending this management approach, as they were worried about the risk of metastases, did not feel that evidence to support this approach was strong enough, and also believed that patients currently have a high preference for surgery. The majority of clinicians did not believe that changing the terminology of this diagnosis was a viable strategy to reduce patients' anxiety and their perceived preference for more aggressive treatments. However, most clinicians felt that thyroid nodules <1 cm should not be biopsied, which could help minimize the risk of overdiagnosis of PMC. CONCLUSIONS: This study, based on a non-representative sample of 22 clinicians, which remains an important limitation, provides revealing insight into clinicians' management preferences and decision making for small low-risk thyroid cancers at a time when management guidelines and practices are evolving. It suggests that clinicians may not be ready to accept nonsurgical options, or changes in terminology, until evidence to support these options and changes is stronger.
Entities:
Keywords:
active surveillance; management; overdiagnosis; overtreatment; papillary microcarcinoma; terminology
Authors: Brooke Nickel; Kirsten Howard; Juan P Brito; Alexandra Barratt; Ray Moynihan; Kirsten McCaffery Journal: JAMA Otolaryngol Head Neck Surg Date: 2018-10-01 Impact factor: 6.223
Authors: Brooke Nickel; Alexandra Barratt; Kevin McGeechan; Juan P Brito; Ray Moynihan; Kirsten Howard; Kirsten McCaffery Journal: JAMA Otolaryngol Head Neck Surg Date: 2018-10-01 Impact factor: 6.223
Authors: Claudio R Cernea; Leandro Luongo Matos; Cecília Eugênio; Giovanna Mattos Ferreira; Yasmin Sa Cerqueira; Ana Kober N Leite; Felipe A B Vanderlei; Dorival de Carlucci; Renato N Gotoda; Flávio C Hojaij; Vergilius J F Araújo-Filho Journal: Curr Oncol Rep Date: 2022-01-21 Impact factor: 5.075
Authors: Brooke Nickel; Caitlin Semsarian; Ray Moynihan; Alexandra Barratt; Susan Jordan; Donald McLeod; Juan P Brito; Kirsten McCaffery Journal: BMJ Open Date: 2019-02-05 Impact factor: 2.692