Alexandria D McDow1, Benjamin R Roman2, Megan C Saucke3, Catherine B Jensen4, Nick Zaborek5, Jamia Linn Jennings6, Louise Davies7, Juan P Brito8, Susan C Pitt9. 1. Division of Surgery Oncology, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive EH 537, Indianapolis, IN, 46202, USA. Electronic address: amcdow@iu.edu. 2. Division of Head and Neck, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA. Electronic address: romanb@mskcc.org. 3. Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Madison, WI, 53792, USA. Electronic address: saucke@surgery.wisc.edu. 4. Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Madison, WI, 53792, USA. Electronic address: cjensen22@wisc.edu. 5. Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Madison, WI, 53792, USA. Electronic address: zaborek@wisc.edu. 6. Wisconsin Department of Health Services, 1 West Wilson Street, Madison, WI, 53703, USA. Electronic address: jamia.jennings@dhs.wisconsin.gov. 7. The VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT, USA and The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, 1 Medical Center Drive, Lebanon, NH, 03756, USA. Electronic address: Louise.Davies@dartmouth.edu. 8. Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. Electronic address: Brito.Juan@mayo.edu. 9. Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Madison, WI, 53792, USA. Electronic address: pitt@surgery.wisc.edu.
Abstract
BACKGROUND: The 2015 American Thyroid Association endorsed less aggressive management for low-risk papillary thyroid cancer (LR-PTC). We aimed to identify factors influencing physicians' recommendations for LR-PTC. METHODS: We surveyed members of three professional societies and assessed respondents' recommendations for managing LR-PTC using patient scenarios. Multivariable logistic regression models identified clinical and non-clinical factors associated with recommending total thyroidectomy (TT) and active surveillance (AS). RESULTS: The 345 respondents included 246 surgeons and 99 endocrinologists. Physicians' preference for their own management if diagnosed with LR-PTC had the strongest association with their recommendation for TT and AS (TT: OR 12.3; AS: OR 7.5, p < 0.001). Physician specialty and stated patient preference were also significantly associated with their recommendations for both management options. Respondents who received information about AS had increased odds of recommending AS. CONCLUSIONS: Physicians' recommendations for LR-PTC are strongly influenced by non-clinical factors, such as personal treatment preference and specialty.
BACKGROUND: The 2015 American Thyroid Association endorsed less aggressive management for low-risk papillary thyroid cancer (LR-PTC). We aimed to identify factors influencing physicians' recommendations for LR-PTC. METHODS: We surveyed members of three professional societies and assessed respondents' recommendations for managing LR-PTC using patient scenarios. Multivariable logistic regression models identified clinical and non-clinical factors associated with recommending total thyroidectomy (TT) and active surveillance (AS). RESULTS: The 345 respondents included 246 surgeons and 99 endocrinologists. Physicians' preference for their own management if diagnosed with LR-PTC had the strongest association with their recommendation for TT and AS (TT: OR 12.3; AS: OR 7.5, p < 0.001). Physician specialty and stated patient preference were also significantly associated with their recommendations for both management options. Respondents who received information about AS had increased odds of recommending AS. CONCLUSIONS: Physicians' recommendations for LR-PTC are strongly influenced by non-clinical factors, such as personal treatment preference and specialty.
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