Department of Surgery, School of Medicine, University of Michigan, Ann Arbor, MI. Electronic address: https://twitter.com/@HJUnderwoodMD.
Department of Surgery, School of Medicine, University of Michigan, Ann Arbor, MI. Electronic address: https://twitter.com/@nmmott.
Surgery. 2023 Jan;173(1):226-231. doi: 10.1016/j.surg.2022.05.049. Epub 2022 Nov 3.
Shared decision-making about treatment for low-risk thyroid cancer requires patients and surgeons to work together to select treatment that best balances risks and expected outcomes with patient preferences and values. To participate, patients must be activated and ask questions. We aimed to characterize what topics patients prioritize during treatment decision-making.
We identified substantive questions by patients with low-risk (cT1-2, N0) thyroid cancer during audio-recorded consultations with 9 surgeons at 2 unique health care systems. Logistics questions were excluded. Qualitative content analysis was used to identify major themes among patients' questions and surgeon responses.
Overall, 28 of 30 patients asked 253 substantive questions, with 2 patients not asking any substantive questions (median 8, range 0-25). Patients were 20 to 71 years old, mostly White (86.7%) and female (80.0%). The questions addressed extent of surgery, hormone supplementation, risk of cancer progression, radioactive iodine, and etiology of thyroid cancer. When patients probed for a recommendation regarding extent of surgery, surgeons often responded indirectly. When patients asked how surgery could impact quality of life, surgeons focused on oncologic benefits and surgical risk. Patients commonly asked about hormone supplementation and radioactive iodine.
Patient questions focused on the decision regarding extent of surgery, quality of life, and nonsurgical aspects of thyroid cancer care. Surgeon responses do not consistently directly answer patients' questions but focus on the risks, benefits, and conduct of surgery itself. These findings suggest an opportunity to help surgeons with resources to improve shared decision-making by providing information that patients prioritize.
低危甲状腺癌的治疗需要医患共同决策，选择最佳的治疗方案，以平衡风险和预期结果、患者偏好和价值观。为了参与决策，患者必须积极主动并提出问题。我们旨在描述患者在治疗决策过程中优先考虑的主题。
我们通过在 2 家独特的医疗保健系统中与 9 位外科医生进行的 9 次音频记录咨询，识别出低危（cT1-2，N0）甲状腺癌患者提出的实质性问题。排除了物流问题。采用定性内容分析法确定患者问题和外科医生回答中的主要主题。
总体而言，30 名患者中的 28 名提出了 253 个实质性问题，其中 2 名患者没有提出任何实质性问题（中位数 8 个，范围 0-25 个）。患者年龄为 20-71 岁，大多数为白人（86.7%）和女性（80.0%）。问题涉及手术范围、激素补充、癌症进展风险、放射性碘和甲状腺癌病因。当患者询问有关手术范围的建议时，外科医生通常会间接回答。当患者询问手术如何影响生活质量时，外科医生专注于肿瘤学益处和手术风险。患者经常询问激素补充和放射性碘的问题。
患者的问题集中在手术范围、生活质量以及甲状腺癌治疗的非手术方面的决策上。外科医生的回答并没有始终直接回答患者的问题，而是侧重于手术本身的风险、益处和进行方式。这些发现表明，有机会通过提供患者优先考虑的信息来帮助外科医生利用资源改善共同决策。
