Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, Sydney, New South Wales, Australia.
Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
JAMA Otolaryngol Head Neck Surg. 2018 Oct 1;144(10):867-874. doi: 10.1001/jamaoto.2018.1272.
Given evidence of overdiagnosis and overtreatment of small papillary thyroid cancers (PTCs), strategies are needed to promote the consideration of less invasive treatment options for patients with low-risk PTC.
To determine the association of treatment preferences and anxiety levels for PTC with the terminology used to describe the condition.
DESIGN, SETTING, AND PARTICIPANTS: This randomized crossover study involved a community sample of 550 Australian men and women 18 years or older without a history of thyroid cancer. Between March 16, 2016, and July 26, 2016, participants accessed an online study that presented 3 hypothetical but clinically realistic scenarios, each of which described PTC as papillary thyroid cancer, papillary lesion, or abnormal cells. Participants were exposed to all 3 scenarios with the different terminologies, and participants were randomized by the order (first, second, or third) in which they viewed the terminologies. Data analysis was conducted from September 1, 2016, to May 15, 2017.
Treatment choice (total thyroidectomy, hemithyroidectomy, or active surveillance), diagnosis anxiety, and treatment choice anxiety.
Of the 550 participants who completed the online study and were included in the analysis, 279 (50.7%) were female and the mean (SD) age was 49.9 (15.2) years. A higher proportion of participants (108 [19.6%]) chose total thyroidectomy when papillary thyroid cancer was used to describe the condition compared with the percentage of participants who chose total thyroidectomy when papillary lesion (58 [10.5%]) or abnormal cells (60 [10.9%]) terminology was used. At first exposure, the papillary thyroid cancer terminology led 60 of 186 participants (32.3%) to choose surgery compared with 46 of 191 participants (24.1%) who chose surgery after being exposed to papillary lesion terminology first (risk ratio [RR], 0.73; 95% CI, 0.53-1.02) and 47 of 173 participants (27.2%) after being exposed to abnormal cells (RR, 0.82; 95% CI, 0.60-1.14) terminology first. After the first exposure, participants who viewed papillary thyroid cancer terminology reported significantly higher levels of anxiety (mean, 7.8 of 11 points) compared with those who viewed the papillary lesion (mean, 7.0 of 11 points; mean difference, -0.8; 95% CI, -1.3 to -0.3) or abnormal cells (mean, 7.3 of 11 points; mean difference, -0.5; 95% CI, -1.0 to 0.01). Overall, interest in active surveillance was high and higher levels of anxiety were reported by those who chose surgery, regardless of which terminology was viewed first (mean difference, 1.5; 95% CI, 1.0-1.9).
Changing the terminology of small PTCs may be one strategy to reduce patients' anxiety levels and help them consider less invasive management options. To curtail overdiagnosis and overtreatment in PTC, other strategies may include providing balanced information about the risks and advantages of alternative treatments.
anzctr.org.au Identifier: ACTRN12616000271404.
鉴于小乳头状甲状腺癌（PTC）存在过度诊断和过度治疗的证据，因此需要制定策略，以促进为低危 PTC 患者考虑采用侵袭性较小的治疗方案。
确定 PTC 治疗偏好和焦虑水平与用于描述该疾病的术语之间的关联。
设计、设置和参与者：这是一项随机交叉研究，纳入了 550 名澳大利亚 18 岁及以上、无甲状腺癌病史的男性和女性社区样本。2016 年 3 月 16 日至 2016 年 7 月 26 日期间，参与者访问了一个在线研究，该研究提供了 3 种假设但临床现实的情况，每种情况均将 PTC 描述为乳头状甲状腺癌、乳头状病变或异常细胞。参与者接触了所有 3 种不同术语的情况，参与者按他们查看术语的顺序（第一、第二或第三）进行随机分组。数据分析于 2017 年 9 月 1 日至 2017 年 5 月 15 日进行。
治疗选择（甲状腺全切除术、甲状腺叶切除术或主动监测）、诊断焦虑和治疗选择焦虑。
在完成在线研究并纳入分析的 550 名参与者中，279 名（50.7%）为女性，平均（SD）年龄为 49.9（15.2）岁。与使用乳头状病变术语时相比，当使用乳头状甲状腺癌术语描述病情时，选择甲状腺全切除术的参与者比例更高（108 例[19.6%]），而选择甲状腺全切除术的参与者比例为 58 例（10.5%）。首次暴露时，186 名参与者中有 60 名（32.3%）选择手术治疗，而 191 名参与者中有 46 名（24.1%）在首次接触乳头状病变术语后选择手术治疗（风险比[RR]，0.73；95%CI，0.53-1.02），173 名参与者中有 47 名（27.2%）在首次接触异常细胞术语后选择手术治疗（RR，0.82；95%CI，0.60-1.14）。首次暴露后，观看乳头状甲状腺癌术语的参与者报告的焦虑水平明显高于观看乳头状病变（平均 7.8 分/11 分）或异常细胞（平均 7.3 分/11 分）术语的参与者（平均差异，-0.8；95%CI，-1.3 至 -0.3）。总的来说，对主动监测很感兴趣，无论首先观看哪种术语，选择手术治疗的参与者报告的焦虑水平更高（平均差异，1.5；95%CI，1.0-1.9）。
改变小 PTC 的术语可能是降低患者焦虑水平并帮助他们考虑采用侵袭性较小的管理方案的一种策略。为了遏制 PTC 的过度诊断和过度治疗，其他策略可能包括提供关于替代治疗风险和优势的平衡信息。
anzctr.org.au 标识符：ACTRN12616000271404。
