Division of Endocrinology and Metabolism, Thyroid Section, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Department of Population Health Sciences, Durham, North Carolina, USA.
Thyroid. 2020 Jul;30(7):1044-1052. doi: 10.1089/thy.2019.0590. Epub 2020 Apr 15.
Patient preferences pertaining to surgical options for thyroid cancer management are not well studied. Our aim was to conduct a discrete choice experiment (DCE) to characterize participants' views on the relative importance of various risks and benefits associated with lobectomy versus total thyroidectomy for low-risk thyroid cancer. Adult participants with low-risk thyroid cancer or a thyroid nodule requiring surgery were asked to choose between experimentally designed surgical options with varying levels of risk of nerve damage (1%, 9%, 14%), hypocalcemia (0%, 3%, 8%), risk of needing a second surgery (0%, 40%), cancer recurrence (1%, 3%, 5%), and need for daily thyroid hormone supplementation (yes, no). Their choices were analyzed using random-parameters logit regression. One hundred fifty participants completed an online DCE survey. Median age was 58 years; 82% were female. Twenty-four participants (16%) had a diagnosis of thyroid cancer at the time of completing the survey, and 126 (84%) had a thyroid nodule necessitating surgery. On average, 35% of participants' choices were explained by differences in the risk of cancer recurrence; 28% by the chance of needing a second surgery; 19% by the risk of nerve damage; and 9% by differences in risks of hypocalcemia and the need for thyroid hormone supplementation. When accounting for differences in postoperative risks, the average patient favored lobectomy over total thyroidectomy as long as the chance of needing a second (i.e., completion) surgery after initial lobectomy remained below 30%. Participants would accept a 4.1% risk of cancer recurrence if the risk of a second surgery could be reduced from 40% to 10%. While patients with thyroid cancer may have clear preferences for extent of surgery, common themes moderating preferences for surgical interventions were identified in the DCE. Adequate preoperative evaluation to decrease the chance of a second surgery and providing patients with a good understanding of risks and benefits associated with extent of surgery can lead to better treatment decision-making.
患者对甲状腺癌管理手术选择的偏好尚未得到充分研究。我们的目的是进行离散选择实验（DCE），以描述参与者对甲状腺癌低风险患者行甲状腺叶切除术与甲状腺全切除术的各种风险和获益的相对重要性的看法。患有低风险甲状腺癌或需要手术的甲状腺结节的成年参与者被要求在具有不同神经损伤风险（1%、9%、14%）、低钙血症风险（0%、3%、8%）、需要二次手术的风险（0%、40%）、癌症复发风险（1%、3%、5%）和需要每日甲状腺激素补充的手术方案（是、否）的实验设计手术方案中进行选择。使用随机参数逻辑回归分析参与者的选择。150 名参与者完成了在线 DCE 调查。中位年龄为 58 岁，82%为女性。24 名参与者（16%）在完成调查时患有甲状腺癌，126 名参与者（84%）患有需要手术的甲状腺结节。平均而言，35%的参与者选择由癌症复发风险差异解释；28%由需要二次手术的机会解释；19%由神经损伤风险解释；9%由低钙血症和甲状腺激素补充的风险差异解释。在考虑术后风险差异的情况下，只要初始甲状腺叶切除术后再次手术（即完成）的几率保持在 30%以下，平均患者就倾向于选择甲状腺叶切除术而非甲状腺全切除术。如果二次手术的风险可以从 40%降低到 10%，患者可以接受 4.1%的癌症复发风险。虽然甲状腺癌患者可能对手术范围有明确的偏好，但 DCE 中确定了调节手术干预偏好的常见主题。充分的术前评估以降低二次手术的机会，并使患者充分了解与手术范围相关的风险和获益，可以导致更好的治疗决策。
