Department of Head and Neck Surgery, The Royal Marsden Hospital, London, UK.
Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK.
JAMA Otolaryngol Head Neck Surg. 2023 May 1;149(5):452-459. doi: 10.1001/jamaoto.2023.0101.
Several international guidelines have endorsed more conservative treatment of low-risk differentiated thyroid cancer (LRDTC), yet patients are facing more treatment options with similar oncologic outcomes and are expressing feelings of confusion, dissatisfaction, and anxiety. Shared decision-making, which considers the patient's values and preferences along with the most reliable medical evidence, has been proposed to optimize patient satisfaction in the context of the current clinical equipoise.
To understand key individual and behavioral factors affecting the patient and clinician decision-making process in treatment decision for LRDTC.
This systematic review and meta-ethnography involved a comprehensive literature search of MEDLINE, Embase, PubMed, and CINAHL databases for qualitative and mixed-method studies on patient and clinician experiences with the decision-making process for LRDTC treatment. The quality of the studies was assessed using the Mixed Methods Appraisal Tool; meta-ethnography was used for data analysis. Primary and secondary themes of the included studies were extracted, compared, and translated across articles to produce a lines-of-argument synthesis.
Of 1081 publications identified, 12 articles met the inclusion criteria. The qualitative synthesis produced 4 themes: (1) a bimodal distribution of patient preferences for treatment decisions; (2) clinician anxiety affected equipoise and biased their recommendations; (3) clinicians struggled to identify patient concerns and preferences; and (4) the clinician-patient relationship and psychosocial support were key to shared decision-making but were frequently overlooked.
The findings of this systematic review and meta-ethnography emphasize the need for better patient-clinician communication, particularly with respect to eliciting patient concerns and preferences. With an ever-increasing pool of thyroid cancer survivors, future efforts should be directed at establishing and evaluating tools that will aid in shared decision-making for treatment of patients with LRDTC.
PROSPERO Identifier: CRD42022286395.
几项国际指南都支持对低危分化型甲状腺癌（LRDTC）采取更保守的治疗方法，但患者面临着更多的治疗选择，这些选择的肿瘤学结果相似，他们感到困惑、不满和焦虑。为了优化当前临床平衡背景下患者的满意度，提出了共同决策，该决策同时考虑患者的价值观和偏好以及最可靠的医学证据。
了解影响 LRDTC 治疗决策中患者和临床医生决策过程的关键个体和行为因素。
本系统评价和元人种学研究全面检索了 MEDLINE、Embase、PubMed 和 CINAHL 数据库中关于患者和临床医生在 LRDTC 治疗决策过程中的经验的定性和混合方法研究。使用混合方法评估工具评估研究的质量；使用元人种学进行数据分析。从纳入的研究中提取主要和次要主题，并在文章之间进行比较和翻译，以产生论点综合。
在 1081 篇出版物中，有 12 篇文章符合纳入标准。定性综合得出 4 个主题：（1）患者对治疗决策的偏好呈双峰分布；（2）临床医生的焦虑影响平衡并影响他们的建议；（3）临床医生难以识别患者的关注和偏好；（4）医患关系和心理社会支持是共同决策的关键，但经常被忽视。
本系统评价和元人种学的研究结果强调需要更好的医患沟通，特别是在引出患者的关注和偏好方面。随着甲状腺癌幸存者人数的不断增加，未来的努力应致力于建立和评估有助于 LRDTC 患者治疗共同决策的工具。
PROSPERO 标识符：CRD42022286395。
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