Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
JAMA Oncol. 2019 Jun 1;5(6):817-823. doi: 10.1001/jamaoncol.2019.0054.
The cancer disease label may lead to overtreatment of low-risk malignant neoplasms owing to a patient's emotional response or misunderstanding of prognosis. Decision making should be driven by risks and benefits of treatment and prognosis rather than disease label.
To determine whether disease label plays a role in patient decision making in the setting of low-risk malignant neoplasms and to determine how the magnitude of the disease-label effect compares with preferences for treatment and prognosis.
DESIGN, SETTING, AND PARTICIPANTS: A discrete choice experiment conducted using an online survey of 1314 US residents in which participants indicated their preferences between a series of 2 hypothetical vignettes describing the incidental discovery of a small thyroid lesion. Vignettes varied on 3 attributes: disease label (cancer, tumor, or nodule); treatment (active surveillance or hemithyroidectomy); and risk of progression or recurrence (0%, 1%, 2%, or 5%). The independent associations of each attribute with likelihood of vignette selection was estimated with a Bayesian mixed logit model.
The preference weight of the cancer disease label was compared with preference weights for other attributes.
In 1068 predominantly healthy respondents (605 women and 463 men) with a median age of 35 years (range, 18-78 years), the cancer disease label played a considerable role in respondent decision making independent of treatment offered and risk of progression or recurrence. Participants accepted a 4-percentage-point increase in risk of progression or recurrence (from 1% to 5%) to avoid labeling their disease as cancer in favor of nodule (marginal rate of substitution [MRS], 1.0; 95% credible interval [CrI], 0.9-1.1). Preference for the nodule label instead of cancer was similar in magnitude to the preference for active surveillance over surgery (MRS, 1.0; 95% CrI, 0.9-1.1).
Disease label plays a role in patient preference independent of treatment risks or prognosis. Raising the threshold for biopsy or removing the word cancer from the disease label may mitigate patient preference for aggressive treatment of low-risk lesions. Health care professionals should emphasize treatment risks and benefits and natural disease history when supporting treatment decisions for potentially innocuous epithelial malignant neoplasms.
由于患者的情绪反应或对预后的误解，癌症疾病标签可能导致对低危恶性肿瘤的过度治疗。决策应该由治疗和预后的风险和益处驱动，而不是疾病标签。
确定疾病标签在低危恶性肿瘤患者决策中的作用，并确定疾病标签效应的大小与对治疗和预后的偏好相比如何。
设计、设置和参与者：使用在线调查对 1314 名美国居民进行了离散选择实验，参与者在描述偶然发现小甲状腺病变的两个假设情景描述之间表明了他们的偏好。情景在 3 个属性上有所不同：疾病标签（癌症、肿瘤或结节）；治疗（主动监测或甲状腺叶切除术）；以及进展或复发的风险（0%、1%、2%或 5%）。使用贝叶斯混合对数模型估计每个属性与情景选择可能性的独立关联。
将癌症疾病标签的偏好权重与其他属性的偏好权重进行了比较。
在 1068 名主要健康的受访者（605 名女性和 463 名男性）中，中位年龄为 35 岁（范围为 18-78 岁），癌症疾病标签在独立于提供的治疗和进展或复发风险的情况下，在患者决策中起着相当大的作用。参与者接受了进展或复发风险增加 4 个百分点（从 1%增加到 5%），以避免将疾病标记为癌症，转而选择结节（边际替代率[MRS]，1.0；95%可信区间[CrI]，0.9-1.1）。与手术相比，选择结节标签而不是癌症的偏好程度与选择主动监测的偏好程度相似（MRS，1.0；95% CrI，0.9-1.1）。
疾病标签在独立于治疗风险或预后的情况下对患者偏好产生影响。提高活检阈值或从疾病标签中删除“癌症”一词可能会减轻患者对低危病变进行积极治疗的偏好。医疗保健专业人员在支持潜在良性上皮恶性肿瘤的治疗决策时，应强调治疗风险和益处以及自然疾病史。
