Duarte Fernanda Barbosa, Faro Fernanda Nascimento, Ward Laura Sterian, Cury Adriano Namo, Ferraz Carolina, Padovani Rosália do Prado
Thyroid Diseases Unit - Division of Endocrinology, Department of Medicine/ Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
Medical Sciences University, State University of Campinas (FCM/Unicamp), Campinas, SP, Brazil.
Heliyon. 2024 Sep 2;10(17):e37300. doi: 10.1016/j.heliyon.2024.e37300. eCollection 2024 Sep 15.
Active surveillance (AS) is increasingly recognized as an appropriate strategy for selected patients with papillary thyroid microcarcinomas (PTMC). However, some factors, including physician-related ones, hinder its widespread adoption.
To explore the prevailing barriers and the impact of information on attitudes towards AS implementation, we developed a questionnaire that was completed before and after reading a simple information leaflet by 317 doctors working in different work environments. This leaflet provides information about the overdiagnosis of PTMC, the concept of AS, results of early studies, and main advantages and disadvantages of AS.
We observed a greater resistance to AS among male physicians who were more likely to maintain the initial recommendation for surgery or referral to a head and neck surgeon than female physicians (77 % vs. 46 %, p = 0.01), regardless of their medical specialty. Fear of disease progression and of the patient losing follow-up were the main concerns. Reading the educational material significantly increased the number of physicians who endorsed AS as an initial approach to PTMC without risk factors from 14 % to 34 % (p < 0,001). This change in attitude was even more significant when doctors were confronted with a case of PTMC in an elderly patient. Gender, medical specialty, age range and academic environment were the factors that were determinants on the influence of the informative leaflet on the decision-making. The leaflet also increased the number of doctors who considered themselves capable of dealing with this patient profile; however, 17 % declared that the place where they worked would not be able to meet the need for periodic assessments and necessary examinations. This was particularly true for the 20 % of the professionals working in rural areas.
A simple educational leaflet with basic information presented via social media increased the number of Brazilian physicians who endorsed AS for PTMC management and proved to be a facilitating tool for understanding and accepting it. Our results suggest that this method can be easily extended to larger population.
主动监测（AS）越来越被认为是部分甲状腺微小乳头状癌（PTMC）患者的一种合适策略。然而，包括医生相关因素在内的一些因素阻碍了其广泛应用。
为探究普遍存在的障碍以及信息对AS实施态度的影响，我们设计了一份问卷，由317名在不同工作环境中工作的医生在阅读一份简单的信息手册前后完成。该手册提供了有关PTMC过度诊断、AS概念、早期研究结果以及AS主要优缺点的信息。
我们观察到，男性医生对AS的抵触情绪更大，无论其医学专业如何，他们比女性医生更倾向于维持手术的初始建议或转诊至头颈外科医生（77%对46%，p = 0.01）。对疾病进展和患者失去随访的担忧是主要顾虑。阅读教育材料后，认可AS作为无危险因素的PTMC初始治疗方法的医生人数从14%显著增加到34%（p < 0.001）。当医生面对老年PTMC患者病例时，这种态度变化更为显著。性别、医学专业、年龄范围和学术环境是信息手册对决策影响的决定性因素。该手册还增加了认为自己有能力处理这类患者的医生人数；然而，17%的医生表示他们工作的地方无法满足定期评估和必要检查的需求。在农村地区工作的20%的专业人员尤其如此。
通过社交媒体呈现基本信息的简单教育手册增加了认可AS用于PTMC管理的巴西医生人数，并被证明是理解和接受它的一种促进工具。我们的结果表明，这种方法可以轻松扩展到更大的人群。
