Clinicians' Views on Management and Terminology for Papillary Thyroid Microcarcinoma: A Qualitative Study

Brooke Nickel, Juan P Brito, Alexandra L Barratt, Susan Jordan, Ray Moynihan, Kirsten J McCaffery

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17 Citations (Scopus)

Abstract

Background: There is growing acceptance that the increase in thyroid cancer incidence is in part a result of overdiagnosis of small low-risk papillary microcarcinomas (PMCs) with indolent clinical course. Although surgery is the cornerstone treatment for patients with PMCs, recent management guidelines are shifting toward inclusion of more conservative treatments such as active surveillance. There is little evidence on clinicians' experience in managing PMC patients and their attitudes toward treatment options, including their willingness to accept a nonsurgical option. The aim of this study was to understand how clinicians perceive a diagnosis of PMC, potential changes to terminology, and the treatment options available to patients. Methods: This was a qualitative study using semi-structured interviews conducted between November 2015 and May 2016 with 22 clinicians (seven endocrinologists and 15 thyroid surgeons). Transcribed audio-recordings were thematically coded, and a framework method was used to analyze the data. Results: Across a sample of clinicians who manage thyroid cancer patients, awareness of overdiagnosis and overtreatment of PMC was common. However, there was little acceptance of active surveillance to manage these patients. Clinicians did not feel comfortable recommending this management approach, as they were worried about the risk of metastases, did not feel that evidence to support this approach was strong enough, and also believed that patients currently have a high preference for surgery. The majority of clinicians did not believe that changing the terminology of this diagnosis was a viable strategy to reduce patients' anxiety and their perceived preference for more aggressive treatments. However, most clinicians felt that thyroid nodules <1 cm should not be biopsied, which could help minimize the risk of overdiagnosis of PMC. Conclusions: This study, based on a non-representative sample of 22 clinicians, which remains an important limitation, provides revealing insight into clinicians' management preferences and decision making for small low-risk thyroid cancers at a time when management guidelines and practices are evolving. It suggests that clinicians may not be ready to accept nonsurgical options, or changes in terminology, until evidence to support these options and changes is stronger.

Original languageEnglish
Pages (from-to)661-671
Number of pages11
JournalThyroid
Volume27
Issue number5
Early online date21 Mar 2017
DOIs
Publication statusPublished - 1 May 2017

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Terminology
Thyroid Neoplasms
Time Management
Thyroid Nodule
Therapeutics
Papillary Thyroid Microcarcinoma
Practice Guidelines
Decision Making
Thyroid Gland
Anxiety
Guidelines
Interviews
Neoplasm Metastasis
Medical Overuse
Incidence

Cite this

Nickel, Brooke ; Brito, Juan P ; Barratt, Alexandra L ; Jordan, Susan ; Moynihan, Ray ; McCaffery, Kirsten J. / Clinicians' Views on Management and Terminology for Papillary Thyroid Microcarcinoma : A Qualitative Study. In: Thyroid. 2017 ; Vol. 27, No. 5. pp. 661-671.
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Clinicians' Views on Management and Terminology for Papillary Thyroid Microcarcinoma : A Qualitative Study. / Nickel, Brooke; Brito, Juan P; Barratt, Alexandra L; Jordan, Susan; Moynihan, Ray; McCaffery, Kirsten J.

In: Thyroid, Vol. 27, No. 5, 01.05.2017, p. 661-671.

Research output: Contribution to journalArticleResearchpeer-review

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AB - Background: There is growing acceptance that the increase in thyroid cancer incidence is in part a result of overdiagnosis of small low-risk papillary microcarcinomas (PMCs) with indolent clinical course. Although surgery is the cornerstone treatment for patients with PMCs, recent management guidelines are shifting toward inclusion of more conservative treatments such as active surveillance. There is little evidence on clinicians' experience in managing PMC patients and their attitudes toward treatment options, including their willingness to accept a nonsurgical option. The aim of this study was to understand how clinicians perceive a diagnosis of PMC, potential changes to terminology, and the treatment options available to patients. Methods: This was a qualitative study using semi-structured interviews conducted between November 2015 and May 2016 with 22 clinicians (seven endocrinologists and 15 thyroid surgeons). Transcribed audio-recordings were thematically coded, and a framework method was used to analyze the data. Results: Across a sample of clinicians who manage thyroid cancer patients, awareness of overdiagnosis and overtreatment of PMC was common. However, there was little acceptance of active surveillance to manage these patients. Clinicians did not feel comfortable recommending this management approach, as they were worried about the risk of metastases, did not feel that evidence to support this approach was strong enough, and also believed that patients currently have a high preference for surgery. The majority of clinicians did not believe that changing the terminology of this diagnosis was a viable strategy to reduce patients' anxiety and their perceived preference for more aggressive treatments. However, most clinicians felt that thyroid nodules <1 cm should not be biopsied, which could help minimize the risk of overdiagnosis of PMC. Conclusions: This study, based on a non-representative sample of 22 clinicians, which remains an important limitation, provides revealing insight into clinicians' management preferences and decision making for small low-risk thyroid cancers at a time when management guidelines and practices are evolving. It suggests that clinicians may not be ready to accept nonsurgical options, or changes in terminology, until evidence to support these options and changes is stronger.

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