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A Prospective Mixed-Methods Study of Decision-Making on Surgery or Active Surveillance for Low-Risk Papillary Thyroid Cancer

Background: Active surveillance (AS) of small, low-risk papillary thyroid cancers (PTCs) is increasingly being considered. There is limited understanding of why individuals with low-risk PTC may choose AS over traditional surgical management. Methods: We present a mixed-methods analysis of a prospec...

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Autores principales: Sawka, Anna M., Ghai, Sangeet, Yoannidis, Tom, Rotstein, Lorne, Gullane, Patrick J., Gilbert, Ralph W., Pasternak, Jesse D., Brown, Dale H., Eskander, Antoine, de Almeida, John R., Irish, Jonathan C., Higgins, Kevin, Enepekides, Danny J., Monteiro, Eric, Banerjee, Avik, Shah, Manish, Gooden, Everton, Zahedi, Afshan, Korman, Mark, Ezzat, Shereen, Jones, Jennifer M., Rac, Valeria E., Tomlinson, George, Stanimirovic, Aleksandra, Gafni, Amiram, Baxter, Nancy N., Goldstein, David P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Mary Ann Liebert, Inc., publishers 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7374636/
https://www.ncbi.nlm.nih.gov/pubmed/32126932
http://dx.doi.org/10.1089/thy.2019.0592
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author Sawka, Anna M.
Ghai, Sangeet
Yoannidis, Tom
Rotstein, Lorne
Gullane, Patrick J.
Gilbert, Ralph W.
Pasternak, Jesse D.
Brown, Dale H.
Eskander, Antoine
de Almeida, John R.
Irish, Jonathan C.
Higgins, Kevin
Enepekides, Danny J.
Monteiro, Eric
Banerjee, Avik
Shah, Manish
Gooden, Everton
Zahedi, Afshan
Korman, Mark
Ezzat, Shereen
Jones, Jennifer M.
Rac, Valeria E.
Tomlinson, George
Stanimirovic, Aleksandra
Gafni, Amiram
Baxter, Nancy N.
Goldstein, David P.
author_facet Sawka, Anna M.
Ghai, Sangeet
Yoannidis, Tom
Rotstein, Lorne
Gullane, Patrick J.
Gilbert, Ralph W.
Pasternak, Jesse D.
Brown, Dale H.
Eskander, Antoine
de Almeida, John R.
Irish, Jonathan C.
Higgins, Kevin
Enepekides, Danny J.
Monteiro, Eric
Banerjee, Avik
Shah, Manish
Gooden, Everton
Zahedi, Afshan
Korman, Mark
Ezzat, Shereen
Jones, Jennifer M.
Rac, Valeria E.
Tomlinson, George
Stanimirovic, Aleksandra
Gafni, Amiram
Baxter, Nancy N.
Goldstein, David P.
author_sort Sawka, Anna M.
collection PubMed
description Background: Active surveillance (AS) of small, low-risk papillary thyroid cancers (PTCs) is increasingly being considered. There is limited understanding of why individuals with low-risk PTC may choose AS over traditional surgical management. Methods: We present a mixed-methods analysis of a prospective observational real-life decision-making study regarding the choice of thyroidectomy or AS for management of localized, low-risk PTCs <2 cm in maximum diameter (NCT03271892). Patients were provided standardized medical information and were interviewed after making their decision (which dictated disease management). We evaluated patients' levels of decision-self efficacy (confidence in medical decision-making ability) at the time information was presented and their level of decision satisfaction after finalizing their decision (using standardized questionnaires). We asked patients to explain the reason for their choice and qualitatively analyzed the results. Results: We enrolled 74 women and 26 men of mean age 52.4 years, with a mean PTC size of 11.0 mm (interquartile range 9.0, 14.0 mm). Seventy-one patients (71.0% [95% confidence interval 60.9–79.4%]) chose AS over surgery. Ninety-four percent (94/100) of participants independently made their own disease management choice; the rest shared the decision with their physician. Participants had a high baseline level of decision self-efficacy (mean 94.3, standard deviation 9.6 on a 100-point scale). Almost all (98%, 98/100) participants reported high decision satisfaction. Factors reported by patients as influencing their decision included the following: perceived risk of thyroidectomy or the cancer, family considerations, treatment timing in the context of life circumstances, and trust in health care providers. Conclusions: In this Canadian study, ∼7 out of 10 patients with small, low-risk PTC, who were offered the choice of AS or surgery, chose AS. Personal perceptions about cancer or thyroidectomy, contextual factors, family considerations, and trust in health care providers strongly influenced patients' disease management choices.
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spelling pubmed-73746362020-07-22 A Prospective Mixed-Methods Study of Decision-Making on Surgery or Active Surveillance for Low-Risk Papillary Thyroid Cancer Sawka, Anna M. Ghai, Sangeet Yoannidis, Tom Rotstein, Lorne Gullane, Patrick J. Gilbert, Ralph W. Pasternak, Jesse D. Brown, Dale H. Eskander, Antoine de Almeida, John R. Irish, Jonathan C. Higgins, Kevin Enepekides, Danny J. Monteiro, Eric Banerjee, Avik Shah, Manish Gooden, Everton Zahedi, Afshan Korman, Mark Ezzat, Shereen Jones, Jennifer M. Rac, Valeria E. Tomlinson, George Stanimirovic, Aleksandra Gafni, Amiram Baxter, Nancy N. Goldstein, David P. Thyroid Thyroid Cancer and Nodules Background: Active surveillance (AS) of small, low-risk papillary thyroid cancers (PTCs) is increasingly being considered. There is limited understanding of why individuals with low-risk PTC may choose AS over traditional surgical management. Methods: We present a mixed-methods analysis of a prospective observational real-life decision-making study regarding the choice of thyroidectomy or AS for management of localized, low-risk PTCs <2 cm in maximum diameter (NCT03271892). Patients were provided standardized medical information and were interviewed after making their decision (which dictated disease management). We evaluated patients' levels of decision-self efficacy (confidence in medical decision-making ability) at the time information was presented and their level of decision satisfaction after finalizing their decision (using standardized questionnaires). We asked patients to explain the reason for their choice and qualitatively analyzed the results. Results: We enrolled 74 women and 26 men of mean age 52.4 years, with a mean PTC size of 11.0 mm (interquartile range 9.0, 14.0 mm). Seventy-one patients (71.0% [95% confidence interval 60.9–79.4%]) chose AS over surgery. Ninety-four percent (94/100) of participants independently made their own disease management choice; the rest shared the decision with their physician. Participants had a high baseline level of decision self-efficacy (mean 94.3, standard deviation 9.6 on a 100-point scale). Almost all (98%, 98/100) participants reported high decision satisfaction. Factors reported by patients as influencing their decision included the following: perceived risk of thyroidectomy or the cancer, family considerations, treatment timing in the context of life circumstances, and trust in health care providers. Conclusions: In this Canadian study, ∼7 out of 10 patients with small, low-risk PTC, who were offered the choice of AS or surgery, chose AS. Personal perceptions about cancer or thyroidectomy, contextual factors, family considerations, and trust in health care providers strongly influenced patients' disease management choices. Mary Ann Liebert, Inc., publishers 2020-07-01 2020-07-10 /pmc/articles/PMC7374636/ /pubmed/32126932 http://dx.doi.org/10.1089/thy.2019.0592 Text en © Anna M. Sawka et al., 2020; Published by Mary Ann Liebert, Inc. This Open Access article is distributed under the terms of the Creative Commons Attribution Noncommercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are cited.
spellingShingle Thyroid Cancer and Nodules
Sawka, Anna M.
Ghai, Sangeet
Yoannidis, Tom
Rotstein, Lorne
Gullane, Patrick J.
Gilbert, Ralph W.
Pasternak, Jesse D.
Brown, Dale H.
Eskander, Antoine
de Almeida, John R.
Irish, Jonathan C.
Higgins, Kevin
Enepekides, Danny J.
Monteiro, Eric
Banerjee, Avik
Shah, Manish
Gooden, Everton
Zahedi, Afshan
Korman, Mark
Ezzat, Shereen
Jones, Jennifer M.
Rac, Valeria E.
Tomlinson, George
Stanimirovic, Aleksandra
Gafni, Amiram
Baxter, Nancy N.
Goldstein, David P.
A Prospective Mixed-Methods Study of Decision-Making on Surgery or Active Surveillance for Low-Risk Papillary Thyroid Cancer
title A Prospective Mixed-Methods Study of Decision-Making on Surgery or Active Surveillance for Low-Risk Papillary Thyroid Cancer
title_full A Prospective Mixed-Methods Study of Decision-Making on Surgery or Active Surveillance for Low-Risk Papillary Thyroid Cancer
title_fullStr A Prospective Mixed-Methods Study of Decision-Making on Surgery or Active Surveillance for Low-Risk Papillary Thyroid Cancer
title_full_unstemmed A Prospective Mixed-Methods Study of Decision-Making on Surgery or Active Surveillance for Low-Risk Papillary Thyroid Cancer
title_short A Prospective Mixed-Methods Study of Decision-Making on Surgery or Active Surveillance for Low-Risk Papillary Thyroid Cancer
title_sort prospective mixed-methods study of decision-making on surgery or active surveillance for low-risk papillary thyroid cancer
topic Thyroid Cancer and Nodules
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7374636/
https://www.ncbi.nlm.nih.gov/pubmed/32126932
http://dx.doi.org/10.1089/thy.2019.0592
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