Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands.
Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.
Eur J Endocrinol. 2021 May 4;184(6):803-812. doi: 10.1530/EJE-20-1490.
Treatment options for Graves' disease (GD) consist of antithyroid drugs (ATD), radioactive iodine (RAI) and total thyroidectomy (TT). Guidelines recommend to discuss these options with patients, taking into account patients' preferences. This study aims to evaluate and compare patients' and clinicians' preferences and the trade-offs made in choosing treatment.
A discrete choice experiment (DCE) was performed with GD patients with a first diagnosis or recurrence in the previous year, and with clinicians. Participants were offered hypothetical treatment options which differed in type of treatment, rates of remission, severe side effects, permanent voice changes and hypocalcemia. Preference heterogeneity was assessed by latent-class analysis.
In this study, 286 (82%) patients and 61 (18%) clinicians participated in the DCE. All treatment characteristics had a significant effect on treatment choice (P < 0.05). Remission rate was the most important determinant and explained 37 and 35% of choices in patients and clinicians, respectively. Both patients and clinicians preferred ATD over surgery and RAI. A strong negative preference toward RAI treatment was observed in a subclass of patients, whereas clinicians preferred RAI over surgery.
For both patients and clinicians, remission rate was the most important determinant of treatment choice and ATD was the most preferred treatment option. Patients had a negative preference toward RAI compared to alternatives, whereas clinicians preferred RAI over surgery. Clinicians should be aware that their personal attitude toward RAI differs from that of their patients. This study on patients' and clinicians' preferences can support shared decision making and thereby improve clinical treatment.
格雷夫斯病（GD）的治疗选择包括抗甲状腺药物（ATD）、放射性碘（RAI）和甲状腺全切除术（TT）。指南建议在考虑患者偏好的情况下，与患者讨论这些选择。本研究旨在评估和比较患者和临床医生的偏好以及在选择治疗方案时的权衡。
对初诊或一年内复发的 GD 患者和临床医生进行了离散选择实验（DCE）。参与者提供了不同治疗类型、缓解率、严重副作用、永久性声音改变和低钙血症的假设治疗方案。通过潜在类别分析评估偏好异质性。
本研究共纳入 286 名（82%）患者和 61 名（18%）临床医生参与了 DCE。所有治疗特征对治疗选择均有显著影响（P<0.05）。缓解率是最重要的决定因素，分别解释了患者和临床医生选择的 37%和 35%。患者和临床医生均优先选择 ATD 而不是手术和 RAI。在患者的一个亚类中观察到对 RAI 治疗的强烈负面偏好，而临床医生则更喜欢 RAI 而不是手术。
对于患者和临床医生来说，缓解率是治疗选择的最重要决定因素，ATD 是最受欢迎的治疗选择。与其他选择相比，患者对 RAI 有负面偏好，而临床医生则更喜欢 RAI 而不是手术。临床医生应该意识到他们对 RAI 的个人态度与患者不同。本研究对患者和临床医生的偏好进行了研究，可以支持共同决策，从而改善临床治疗。
