Juan P Brito1,2, Jae Hoon Moon3, Rebecca Zeuren4, Sung Hye Kong5, Yeo Goon Kim6, Nicole M Iñiguez-Ariza1,7, June Young Choi8, Kyu Eun Lee9, Ji-Hoon Kim10, Ian Hargraves2, Victor Bernet11, Victor M Montori1,2, Young Joo Park5, R Michael Tuttle4. 1. 1 Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota. 2. 2 Knowledge and Evaluation Research Unit , Mayo Clinic, Rochester, Minnesota. 3. 3 Department of Internal Medicine, Seoul National University Bundang Hospital and Seoul National University College of Medicine , Seongnam-si, Korea. 4. 4 Department of Endocrinology Service, Memorial Sloan-Kettering Cancer Center , New York, New York Memorial Sloan Kettering Cancer Center, New York, New York. 5. 5 Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine , Seoul, Korea. 6. 6 Department of Radiology, Seoul National University Bundang Hospital and Seoul National University College of Medicine , Seongnam-si, Korea. 7. 7 Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán , Mexico City, Mexico . 8. 8 Department of Surgery, Seoul National University Bundang Hospital and Seoul National University College of Medicine , Seongnam-si, Korea. 9. 9 Department of Surgery, Seoul National University Hospital and Seoul National University College of Medicine , Seoul, Korea. 10. 10 Radiology, Seoul National University Hospital and Seoul National University College of Medicine , Seoul, Korea. 11. 11 Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic , Jacksonville, Florida.
Abstract
BACKGROUND: The 2015 American Thyroid Association guidelines recognize active surveillance as an alternative to immediate surgery in patients with papillary microcarcinomas (PMCs). As a way to incorporate active surveillance as one of the management options for patients with PMCs, we developed and tested a tool to support conversations between clinicians and patients with PMCs considering treatment options. METHODS: Thyroid Cancer Treatment Choice was developed using an iterative process based on the principles of interaction, design, and participatory action research. To evaluate the impact of the tool on treatment choice, a prospective study was conducted in two thyroid cancer clinics in Seongnam-si and Seoul, South Korea. Both clinics had the expertise to offer active surveillance as well as immediate surgery. One clinic was trained in the use of the conversation aid, while the other clinic continued to care for patients without access to the conversation aid. RESULTS: Between May 2016 and April 2017, 278 patients, mostly women (n = 220, 79%), were included in the study; 152 (53%) received care at the clinic using the conversation aid. Age, sex, and mean (±SD) tumor size (6.6 ± 1.6 mm and 6.5 ± 1.9 mm) distributions were similar across clinics. Overall, 233 (84%) patients opted for active surveillance and 53 (16%) for thyroid surgery. Patients in the conversation aid group were more likely to choose active surveillance than the patients seen in the usual care clinic (relative risk = 1.16 [confidence interval 1.04-1.29]). Of all patients opting for active surveillance, more patients in the conversation aid group had thyroid cancer nodules >5 mm than in the usual care group (81% vs. 67%; p = 0.013). CONCLUSIONS: Thyroid Cancer Treatment Choice is an evidence-based tool that supports the presentation of treatment options for PMCs. Pilot testing suggests that this conversation tool increases acceptance of active surveillance, suggesting that this option is an acceptable and preferable alternative for informed patients. Further studies are warranted to confirm this finding.
BACKGROUND: The 2015 American Thyroid Association guidelines recognize active surveillance as an alternative to immediate surgery in patients with papillary microcarcinomas (PMCs). As a way to incorporate active surveillance as one of the management options for patients with PMCs, we developed and tested a tool to support conversations between clinicians and patients with PMCs considering treatment options. METHODS:Thyroid Cancer Treatment Choice was developed using an iterative process based on the principles of interaction, design, and participatory action research. To evaluate the impact of the tool on treatment choice, a prospective study was conducted in two thyroid cancer clinics in Seongnam-si and Seoul, South Korea. Both clinics had the expertise to offer active surveillance as well as immediate surgery. One clinic was trained in the use of the conversation aid, while the other clinic continued to care for patients without access to the conversation aid. RESULTS: Between May 2016 and April 2017, 278 patients, mostly women (n = 220, 79%), were included in the study; 152 (53%) received care at the clinic using the conversation aid. Age, sex, and mean (±SD) tumor size (6.6 ± 1.6 mm and 6.5 ± 1.9 mm) distributions were similar across clinics. Overall, 233 (84%) patients opted for active surveillance and 53 (16%) for thyroid surgery. Patients in the conversation aid group were more likely to choose active surveillance than the patients seen in the usual care clinic (relative risk = 1.16 [confidence interval 1.04-1.29]). Of all patients opting for active surveillance, more patients in the conversation aid group had thyroid cancer nodules >5 mm than in the usual care group (81% vs. 67%; p = 0.013). CONCLUSIONS:Thyroid Cancer Treatment Choice is an evidence-based tool that supports the presentation of treatment options for PMCs. Pilot testing suggests that this conversation tool increases acceptance of active surveillance, suggesting that this option is an acceptable and preferable alternative for informed patients. Further studies are warranted to confirm this finding.
Entities:
Keywords:
active surveillance; shared decision making; thyroid cancer
Authors: Elisa Pasqual; Julie Ann Sosa; Yingxi Chen; Sara J Schonfeld; Amy Berrington de González; Cari M Kitahara Journal: Thyroid Date: 2022-03-15 Impact factor: 6.506
Authors: Alexandria D McDow; Benjamin R Roman; Megan C Saucke; Catherine B Jensen; Nick Zaborek; Jamia Linn Jennings; Louise Davies; Juan P Brito; Susan C Pitt Journal: Am J Surg Date: 2020-11-12 Impact factor: 3.125
Authors: G E Collée; B J van der Wilk; J J B van Lanschot; J J Busschbach; L Timmermans; S M Lagarde; L W Kranenburg Journal: Curr Oncol Rep Date: 2020-07-28 Impact factor: 5.075