Benjamin R Roman1, Juan P Brito2, Megan C Saucke3, Shivangi Lohia4, Catherine B Jensen3, Nick Zaborek3, Jamia Linn Jennings5, Robert M Tuttle4, Louise Davies6, Susan C Pitt3. 1. Head and Neck Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: romanb@mskcc.org. 2. Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota. 3. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. 4. Head and Neck Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York. 5. Wisconsin Department of Health Services, Madison, Wisconsin. 6. Department of Veterans Affairs Medical Center, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
Abstract
OBJECTIVE: Active surveillance for low-risk papillary thyroid cancer (PTC) was endorsed by the American Thyroid Association guidelines in 2015. The attitudes and beliefs of physicians treating thyroid cancer regarding the active surveillance approach are not known. METHODS: A national survey of endocrinologists and surgeons treating thyroid cancer was conducted from August to September 2017 via professional society emails. This mixed-methods analysis reported attitudes toward potential factors impacting decision-making regarding active surveillance, beliefs about barriers and facilitators of its use, and reasons why physicians would pick a given management strategy for themselves if they were diagnosed with a low-risk PTC. Survey items about attitudes and beliefs were derived from the Cabana model of barriers to guideline adherence and theoretical domains framework of behavior change. RESULTS: Among 345 respondents, 324 (94%) agreed that active surveillance was appropriate for at least some patients, 81% agreed that active surveillance was at least somewhat underused, and 76% said that they would choose surgery for themselves if diagnosed with a PTC of ≤1 cm. Majority of the respondents believed that the guidelines supporting active surveillance were too vague and that the current supporting evidence was too weak. Malpractice and financial concerns were identified as additional barriers to offering active surveillance. The respondents endorsed improved information resources and evidence as possible facilitators to offering active surveillance. CONCLUSION: Although there is general support among physicians who treat low-risk PTC for the active surveillance approach, there is reluctance to offer it because of the lack of robust evidence, guidelines, and protocols.
OBJECTIVE: Active surveillance for low-risk papillary thyroid cancer (PTC) was endorsed by the American Thyroid Association guidelines in 2015. The attitudes and beliefs of physicians treating thyroid cancer regarding the active surveillance approach are not known. METHODS: A national survey of endocrinologists and surgeons treating thyroid cancer was conducted from August to September 2017 via professional society emails. This mixed-methods analysis reported attitudes toward potential factors impacting decision-making regarding active surveillance, beliefs about barriers and facilitators of its use, and reasons why physicians would pick a given management strategy for themselves if they were diagnosed with a low-risk PTC. Survey items about attitudes and beliefs were derived from the Cabana model of barriers to guideline adherence and theoretical domains framework of behavior change. RESULTS: Among 345 respondents, 324 (94%) agreed that active surveillance was appropriate for at least some patients, 81% agreed that active surveillance was at least somewhat underused, and 76% said that they would choose surgery for themselves if diagnosed with a PTC of ≤1 cm. Majority of the respondents believed that the guidelines supporting active surveillance were too vague and that the current supporting evidence was too weak. Malpractice and financial concerns were identified as additional barriers to offering active surveillance. The respondents endorsed improved information resources and evidence as possible facilitators to offering active surveillance. CONCLUSION: Although there is general support among physicians who treat low-risk PTC for the active surveillance approach, there is reluctance to offer it because of the lack of robust evidence, guidelines, and protocols.
Authors: Anna M Sawka; Richard W Tsang; James D Brierley; Lorne Rotstein; Phillip Segal; Shereen Ezzat; David P Goldstein Journal: Acta Oncol Date: 2016-05-13 Impact factor: 4.089
Authors: Susan C Pitt; Nan Yang; Megan C Saucke; Nicholas Marka; Bret Hanlon; Kristin L Long; Alexandria D McDow; J P Brito; Benjamin R Roman Journal: J Clin Endocrinol Metab Date: 2021-03-25 Impact factor: 5.958