与医生推荐低危型甲状腺乳头状癌管理方案相关的因素。
Factors associated with physicians' recommendations for managing low-risk papillary thyroid cancer.
机构信息
Division of Surgery Oncology, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive EH 537, Indianapolis, IN, 46202, USA.
Division of Head and Neck, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
出版信息
Am J Surg. 2021 Jul;222(1):111-118. doi: 10.1016/j.amjsurg.2020.11.021. Epub 2020 Nov 12.
BACKGROUND
The 2015 American Thyroid Association endorsed less aggressive management for low-risk papillary thyroid cancer (LR-PTC). We aimed to identify factors influencing physicians' recommendations for LR-PTC.
METHODS
We surveyed members of three professional societies and assessed respondents' recommendations for managing LR-PTC using patient scenarios. Multivariable logistic regression models identified clinical and non-clinical factors associated with recommending total thyroidectomy (TT) and active surveillance (AS).
RESULTS
The 345 respondents included 246 surgeons and 99 endocrinologists. Physicians' preference for their own management if diagnosed with LR-PTC had the strongest association with their recommendation for TT and AS (TT: OR 12.3; AS: OR 7.5, p < 0.001). Physician specialty and stated patient preference were also significantly associated with their recommendations for both management options. Respondents who received information about AS had increased odds of recommending AS.
CONCLUSIONS
Physicians' recommendations for LR-PTC are strongly influenced by non-clinical factors, such as personal treatment preference and specialty.
背景
2015 年美国甲状腺协会（ATA）支持对低危甲状腺乳头状癌（LR-PTC）采取不那么积极的治疗方法。我们旨在确定影响医生对 LR-PTC 治疗建议的因素。
方法
我们调查了三个专业协会的成员，并使用患者情况评估了受访者对 LR-PTC 管理的建议。多变量逻辑回归模型确定了与推荐全甲状腺切除术（TT）和主动监测（AS）相关的临床和非临床因素。
结果
345 名受访者包括 246 名外科医生和 99 名内分泌学家。如果被诊断为 LR-PTC，医生对自己管理的偏好与他们推荐 TT 和 AS 的意愿关系最密切（TT：OR 12.3；AS：OR 7.5，p<0.001）。医生的专业和患者的首选治疗方案也与这两种治疗方案的推荐显著相关。收到有关 AS 信息的受访者推荐 AS 的可能性增加。
结论
医生对 LR-PTC 的治疗建议受到非临床因素的强烈影响，如个人治疗偏好和专业。
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