What are the challenges of the current decision-making process for treatment of low-risk differentiated thyroid cancer (LRDTC)?
This systematic review and meta-ethnography of 12 qualitative and/or mixed-method studies on patient and clinician experiences with LRDTC treatment decision-making found a bimodal distribution divided by either a fear of disease progression or of adverse effects and decline in quality of life. In addition, clinicians struggled to identify and understand patient concerns, and recommendations were biased by the clinician’s perceptions of the patient’s risk tolerance and anxiety.
The findings of the systematic review and meta-ethnography suggest that without exploring patient concerns and preferences, LRDTC treatment decisions may not reflect the patient’s values, goals, and long-term wishes, which may be a factor in the overtreatment of LRDTC.
Several international guidelines have endorsed more conservative treatment of low-risk differentiated thyroid cancer (LRDTC), yet patients are facing more treatment options with similar oncologic outcomes and are expressing feelings of confusion, dissatisfaction, and anxiety. Shared decision-making, which considers the patient’s values and preferences along with the most reliable medical evidence, has been proposed to optimize patient satisfaction in the context of the current clinical equipoise.
To understand key individual and behavioral factors affecting the patient and clinician decision-making process in treatment decision for LRDTC.
This systematic review and meta-ethnography involved a comprehensive literature search of MEDLINE, Embase, PubMed, and CINAHL databases for qualitative and mixed-method studies on patient and clinician experiences with the decision-making process for LRDTC treatment. The quality of the studies was assessed using the Mixed Methods Appraisal Tool; meta-ethnography was used for data analysis. Primary and secondary themes of the included studies were extracted, compared, and translated across articles to produce a lines-of-argument synthesis.
Of 1081 publications identified, 12 articles met the inclusion criteria. The qualitative synthesis produced 4 themes: (1) a bimodal distribution of patient preferences for treatment decisions; (2) clinician anxiety affected equipoise and biased their recommendations; (3) clinicians struggled to identify patient concerns and preferences; and (4) the clinician-patient relationship and psychosocial support were key to shared decision-making but were frequently overlooked.
Conclusions and Relevance
The findings of this systematic review and meta-ethnography emphasize the need for better patient-clinician communication, particularly with respect to eliciting patient concerns and preferences. With an ever-increasing pool of thyroid cancer survivors, future efforts should be directed at establishing and evaluating tools that will aid in shared decision-making for treatment of patients with LRDTC.
PROSPERO Identifier: CRD42022286395
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Accepted for Publication: January 26, 2023.
Published Online: March 23, 2023. doi:10.1001/jamaoto.2023.0101
Corresponding Author: Wanding Yang, MBChB, Department of Head and Neck Surgery, Royal Marsden NHS Foundation Trust, 203 Fulham Rd, London SW3 6JJ, UK (firstname.lastname@example.org).
Author Contributions: Drs Yang and Rogers had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Yang, Lorgelly, Rogers, Kim.
Acquisition, analysis, or interpretation of data: Yang, Lee, Kim.
Drafting of the manuscript: Yang, Kim.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Yang.
Obtained funding: Kim.
Administrative, technical, or material support: Yang, Rogers, Kim.
Supervision: Lorgelly, Rogers, Kim.
Conflict of Interest Disclosures: Dr Yang reported academic support from The Royal Marsden Cancer Charity during the conduct of the study. No other disclosures were reported.
Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:
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