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

被引：52

作者：

Sawka, Anna M. ^{[1
,2
]}

Ghai, Sangeet ^{[3
]}

Yoannidis, Tom ^{[4
]}

Rotstein, Lorne ^{[2
,5
]}

Gullane, Patrick J. ^{[2
,6
]}

Gilbert, Ralph W. ^{[2
,6
]}

Pasternak, Jesse D. ^{[2
,5
]}

Brown, Dale H. ^{[2
,6
]}

Eskander, Antoine ^{[2
,7
]}

de Almeida, John R. ^{[2
,6
]}

Irish, Jonathan C. ^{[2
,6
]}

Higgins, Kevin ^{[2
,7
]}

Enepekides, Danny J. ^{[2
,7
]}

Monteiro, Eric ^{[2
,8
]}

Banerjee, Avik ^{[9
]}

Shah, Manish ^{[2
,6
,10
]}

Gooden, Everton ^{[2
,10
]}

Zahedi, Afshan ^{[2
,11
]}

Korman, Mark ^{[12
,13
]}

Ezzat, Shereen ^{[14
]}

Jones, Jennifer M. ^{[2
,15
]}

Rac, Valeria E. ^{[16
,17
,18
,19
,20
,21
]}

Tomlinson, George ^{[18
,19
,20
,21
]}

Stanimirovic, Aleksandra ^{[17
,18
]}

Gafni, Amiram ^{[22
]}

Baxter, Nancy N. ^{[2
,23
]}

Goldstein, David P. ^{[2
,6
]}

机构：

[1] Univ Hlth Network, Div Endocrinol, Toronto, ON, Canada

[2] Univ Toronto, Toronto, ON, Canada

[3] Univ Toronto, Univ Hlth Network, Joint Dept Med Imaging, Mt Sinai Hosp,Womens Coll Hosp, Toronto, ON, Canada

[4] Univ Hlth Network, Dept Otolaryngol Head & Neck Surg, Toronto, ON, Canada

[5] Univ Hlth Network, Dept Surg, Toronto, ON, Canada

[6] Univ Hlth Network, Princess Margaret Canc Ctr, Dept Otolaryngol Head & Neck Surg Surg Oncol, Toronto, ON, Canada

[7] Sunnybrook Hlth Sci Ctr, Dept Otolaryngol & Head & Neck Surg, Toronto, ON, Canada

[8] Mt Sinai Hosp, Dept Otolaryngol & Head & Neck Surg, Toronto, ON, Canada

[9] Grand River Hosp Corp, Dept Otolaryngol & Head & Neck Surg, Kitchener, ON, Canada

[10] North York Gen Hosp, Dept Otolaryngol & Head & Neck Surg, Toronto, ON, Canada

[11] Mt Sinai Hosp, Womens Coll Hosp, Div Endocrinol, Toronto, ON, Canada

[12] William Osler Hlth Syst, Dept Otolaryngol & Head & Neck Surg, Brampton, ON, Canada

[13] Univ Toronto, Brampton, ON, Canada

[14] Princess Margaret Canc Ctr, Div Endocrine Oncol, Toronto, ON, Canada

[15] Univ Hlth Network, Dept Psychosocial Oncol, Toronto, ON, Canada

[16] UHN, TGHRI, Ted Rogers Ctr Heart Res Peter Munk Cardiac Ctr, Toronto, ON, Canada

[17] Univ Toronto, Dalla Lana Sch Publ Hlth, IHPME, Toronto, ON, Canada

[18] Univ Hlth Network, Toronto Gen Hosp Res Inst, Toronto Hlth Econ & Technol Assessment Collaborat, Toronto, ON, Canada

[19] Univ Toronto, Dept Med Univ Hlth Network, Toronto, ON, Canada

[20] Univ Toronto, Mt Sinai Hosp, Toronto, ON, Canada

[21] Univ Toronto, Dalla Lana Sch Publ Hlth, Toronto, ON, Canada

[22] McMaster Univ, Ctr Hlth Econ & Policy Anal, Dept Hlth Res Methods Evaluat & Implementat, Hamilton, ON, Canada

[23] St Michaels Hosp, Dept Surg, Toronto, ON, Canada

来源：

THYROID | 2020年 / 30卷 / 07期

基金：

加拿大健康研究院;

关键词：

active surveillance; thyroidectomy; medical decision-making; prospective observational study; mixed methods; MICROCARCINOMA; MANAGEMENT; SATISFACTION; PROGRESSION; GUIDELINES; TRENDS;

D O I：

10.1089/thy.2019.0592

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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, similar to 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.

引用

页码：999 / 1007

页数：9

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