M. F. Bates1, M. C. Saucke1, J. L. Jennings1, H. J. Khokhar1, C. I. Voils1, S. C. Pitt1 1University Of Wisconsin,Madison, WI, USA
Introduction:
Papillary thyroid microcarcinoma (PTMC) is an overtreated disease where achieving value-concordant care is critical. Patients have three treatment options with equivalent survival outcomes, yet widely varying risks. We aimed to better understand patients’ and surgeons’ decision making about PTMC treatment.
Methods:
This cross-sectional, mixed-methods study of 10 patients with PTMC post-thyroidectomy and 12 surgeons, used semi-structured interviews and a survey that included validated measures of decision control and involvement. We utilized qualitative content analysis to characterize decision-making preferences.
Results:
The majority of patients were white (90%) and female (80%), with a median age of 46 years. Most surgeons were white (91.7%), male (83.3%), endocrine surgeons (83.3%) who worked at university/academic institutions (91.7%). Patients and surgeons both preferred the patient to make the final treatment decision after considering the surgeon’s opinion. They least preferred to leave the final decision to the surgeon.
Examination of patient decision-making showed that 20% of patients did not have as much input as they wanted in their treatment choice and their decision was not consistent with their personal values. Patient experiences ranged from deciding on their treatment prior to surgical consultation, to a perceived lack of a choice because the surgeon only discussed one option. When asked what was most important in choosing a treatment, patients frequently discussed getting the cancer out and trust in the surgeon. The survey demonstrated that 70% of patients felt the surgeon’s recommendation was the most important factor in their decision.
Multiple factors influenced surgeons’ treatment recommendations – most commonly clinical data and patients’ anxiety. Surgeons described tailoring their recommendation based on their own perception of patients’ level of fear and tolerance of risk without explicit discussion. When surveyed, only 58% of surgeons assessed patients’ preferred treatment, and just 42% elicited patients’ preferred level of involvement in decision-making
Conclusion:
When making decisions about PTMC treatment, patients and surgeons prefer a shared model with the patient controlling the final decision. Surgeons’ recommendations appear to heavily influence the decision, but are based on the surgeon’s own perceptions of patients’ preferences, which may not be accurate. To achieve value-concordant patient-centered care, explicit discussion of patients’ preferences in relation to all treatment options and outcomes will be key.