Thyroid Cancer Treatment Choice: A Pilot Study of a Tool to Facilitate Conversations with Patients with Papillary Microcarcinomas Considering Treatment Options

Juan Brito Campana, Jae Hoon Moon, Rebecca Zeuren, Sung Hye Kong, Yeo Goon Kim, Nicole M. Iñiguez-Ariza, June Young Choi, Kyu Eun Lee, Ji Hoon Kim, Ian Hargraves, Victor Bernet, Victor Manuel Montori, Young Joo Park, R. Michael Tuttle

Research output: Contribution to journalArticle

8 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1325-1331
Number of pages7
JournalThyroid
Volume28
Issue number10
DOIs
StatePublished - Oct 1 2018

Keywords

  • active surveillance
  • shared decision making
  • thyroid cancer

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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    Brito Campana, J., Moon, J. H., Zeuren, R., Kong, S. H., Kim, Y. G., Iñiguez-Ariza, N. M., Choi, J. Y., Lee, K. E., Kim, J. H., Hargraves, I., Bernet, V., Montori, V. M., Park, Y. J., & Tuttle, R. M. (2018). Thyroid Cancer Treatment Choice: A Pilot Study of a Tool to Facilitate Conversations with Patients with Papillary Microcarcinomas Considering Treatment Options. Thyroid, 28(10), 1325-1331. https://doi.org/10.1089/thy.2018.0105