Patients' experiences of diagnosis and management of papillary thyroid microcarcinoma: a qualitative study

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

Research output: Contribution to journalArticleResearchpeer-review

6 Citations (Scopus)
48 Downloads (Pure)

Abstract

BACKGROUND: In recent years management practices in relation to low-risk papillary microcarcinoma (PMC) have been evolving with increased awareness of the potential overdiagnosis and overtreatment of PMCs, and guidelines recommendations for non-surgical management options such as active surveillance. This study aimed to develop an in-depth understanding of patients' experiences of the communication of their PMC diagnosis, their treatment preferences and decision making.

METHODS: Semi-structured qualitative interviews with 25 patients diagnosed pre-operatively with PMC < 1 year since their diagnosis and treatment. Interviews were conducted between September 2015 and July 2016 and were audio-recorded and transcribed verbatim. Framework analysis method was used to analyse the data.

RESULTS: The diagnosis and treatment experience of PMC patients varied widely. The majority of patients were asymptomatic, and their PMC was initially detected via an imaging test requested for a reason unrelated to a thyroid disorder or symptom. Clinicians generally described PMC to patients as being a "small" or "slow-growing" cancer, and there was little evidence that clinicians had discussions about the possibility of overdiagnosis or overtreatment. Overall, surgery was the only option discussed and offered to patients. Patients preference for treatment was largely based on eliminating the possibility of the cancer spreading (thyroidectomy) or not wanting to be on thyroid replacement medication for the rest of their life (hemi-thyroidectomy). Many patients reported emotional and physical side-effects associated with their diagnosis and treatment, however patients generally indicated that active surveillance is not something they would have been interested in if it was offered to them.

CONCLUSIONS: Evidence continues to emerge that many patients with PMCs may be overdiagnosed, and management guidelines are recommending more conservative management options for these patients. As a result, shared decision making around treatment options is vital so that patients are fully aware of the meaning of their diagnosis and their management options including active surveillance. Importantly, interventions to reduce unnecessary diagnoses of PMC are critically needed.

Original languageEnglish
Article number242
Number of pages10
JournalBMC Cancer
Volume18
Issue number1
DOIs
Publication statusPublished - 2 Mar 2018

Fingerprint

Thyroidectomy
Decision Making
Thyroid Gland
Papillary Thyroid Microcarcinoma
Therapeutics
Guidelines
Interviews
Patient Preference
Practice Management
Neoplasms
Communication
Medical Overuse
Conservative Treatment

Cite this

Nickel, Brooke ; Brito, Juan P ; Moynihan, Ray ; Barratt, Alexandra ; Jordan, Susan ; McCaffery, Kirsten. / Patients' experiences of diagnosis and management of papillary thyroid microcarcinoma: a qualitative study. In: BMC Cancer. 2018 ; Vol. 18, No. 1.
@article{2e087736e0a248a3908d338f8d60c69b,
title = "Patients' experiences of diagnosis and management of papillary thyroid microcarcinoma: a qualitative study",
abstract = "BACKGROUND: In recent years management practices in relation to low-risk papillary microcarcinoma (PMC) have been evolving with increased awareness of the potential overdiagnosis and overtreatment of PMCs, and guidelines recommendations for non-surgical management options such as active surveillance. This study aimed to develop an in-depth understanding of patients' experiences of the communication of their PMC diagnosis, their treatment preferences and decision making.METHODS: Semi-structured qualitative interviews with 25 patients diagnosed pre-operatively with PMC < 1 year since their diagnosis and treatment. Interviews were conducted between September 2015 and July 2016 and were audio-recorded and transcribed verbatim. Framework analysis method was used to analyse the data.RESULTS: The diagnosis and treatment experience of PMC patients varied widely. The majority of patients were asymptomatic, and their PMC was initially detected via an imaging test requested for a reason unrelated to a thyroid disorder or symptom. Clinicians generally described PMC to patients as being a {"}small{"} or {"}slow-growing{"} cancer, and there was little evidence that clinicians had discussions about the possibility of overdiagnosis or overtreatment. Overall, surgery was the only option discussed and offered to patients. Patients preference for treatment was largely based on eliminating the possibility of the cancer spreading (thyroidectomy) or not wanting to be on thyroid replacement medication for the rest of their life (hemi-thyroidectomy). Many patients reported emotional and physical side-effects associated with their diagnosis and treatment, however patients generally indicated that active surveillance is not something they would have been interested in if it was offered to them.CONCLUSIONS: Evidence continues to emerge that many patients with PMCs may be overdiagnosed, and management guidelines are recommending more conservative management options for these patients. As a result, shared decision making around treatment options is vital so that patients are fully aware of the meaning of their diagnosis and their management options including active surveillance. Importantly, interventions to reduce unnecessary diagnoses of PMC are critically needed.",
author = "Brooke Nickel and Brito, {Juan P} and Ray Moynihan and Alexandra Barratt and Susan Jordan and Kirsten McCaffery",
year = "2018",
month = "3",
day = "2",
doi = "10.1186/s12885-018-4152-9",
language = "English",
volume = "18",
journal = "BMC Cancer",
issn = "1471-2407",
publisher = "BioMed Central",
number = "1",

}

Patients' experiences of diagnosis and management of papillary thyroid microcarcinoma: a qualitative study. / Nickel, Brooke; Brito, Juan P; Moynihan, Ray; Barratt, Alexandra; Jordan, Susan; McCaffery, Kirsten.

In: BMC Cancer, Vol. 18, No. 1, 242, 02.03.2018.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Patients' experiences of diagnosis and management of papillary thyroid microcarcinoma: a qualitative study

AU - Nickel, Brooke

AU - Brito, Juan P

AU - Moynihan, Ray

AU - Barratt, Alexandra

AU - Jordan, Susan

AU - McCaffery, Kirsten

PY - 2018/3/2

Y1 - 2018/3/2

N2 - BACKGROUND: In recent years management practices in relation to low-risk papillary microcarcinoma (PMC) have been evolving with increased awareness of the potential overdiagnosis and overtreatment of PMCs, and guidelines recommendations for non-surgical management options such as active surveillance. This study aimed to develop an in-depth understanding of patients' experiences of the communication of their PMC diagnosis, their treatment preferences and decision making.METHODS: Semi-structured qualitative interviews with 25 patients diagnosed pre-operatively with PMC < 1 year since their diagnosis and treatment. Interviews were conducted between September 2015 and July 2016 and were audio-recorded and transcribed verbatim. Framework analysis method was used to analyse the data.RESULTS: The diagnosis and treatment experience of PMC patients varied widely. The majority of patients were asymptomatic, and their PMC was initially detected via an imaging test requested for a reason unrelated to a thyroid disorder or symptom. Clinicians generally described PMC to patients as being a "small" or "slow-growing" cancer, and there was little evidence that clinicians had discussions about the possibility of overdiagnosis or overtreatment. Overall, surgery was the only option discussed and offered to patients. Patients preference for treatment was largely based on eliminating the possibility of the cancer spreading (thyroidectomy) or not wanting to be on thyroid replacement medication for the rest of their life (hemi-thyroidectomy). Many patients reported emotional and physical side-effects associated with their diagnosis and treatment, however patients generally indicated that active surveillance is not something they would have been interested in if it was offered to them.CONCLUSIONS: Evidence continues to emerge that many patients with PMCs may be overdiagnosed, and management guidelines are recommending more conservative management options for these patients. As a result, shared decision making around treatment options is vital so that patients are fully aware of the meaning of their diagnosis and their management options including active surveillance. Importantly, interventions to reduce unnecessary diagnoses of PMC are critically needed.

AB - BACKGROUND: In recent years management practices in relation to low-risk papillary microcarcinoma (PMC) have been evolving with increased awareness of the potential overdiagnosis and overtreatment of PMCs, and guidelines recommendations for non-surgical management options such as active surveillance. This study aimed to develop an in-depth understanding of patients' experiences of the communication of their PMC diagnosis, their treatment preferences and decision making.METHODS: Semi-structured qualitative interviews with 25 patients diagnosed pre-operatively with PMC < 1 year since their diagnosis and treatment. Interviews were conducted between September 2015 and July 2016 and were audio-recorded and transcribed verbatim. Framework analysis method was used to analyse the data.RESULTS: The diagnosis and treatment experience of PMC patients varied widely. The majority of patients were asymptomatic, and their PMC was initially detected via an imaging test requested for a reason unrelated to a thyroid disorder or symptom. Clinicians generally described PMC to patients as being a "small" or "slow-growing" cancer, and there was little evidence that clinicians had discussions about the possibility of overdiagnosis or overtreatment. Overall, surgery was the only option discussed and offered to patients. Patients preference for treatment was largely based on eliminating the possibility of the cancer spreading (thyroidectomy) or not wanting to be on thyroid replacement medication for the rest of their life (hemi-thyroidectomy). Many patients reported emotional and physical side-effects associated with their diagnosis and treatment, however patients generally indicated that active surveillance is not something they would have been interested in if it was offered to them.CONCLUSIONS: Evidence continues to emerge that many patients with PMCs may be overdiagnosed, and management guidelines are recommending more conservative management options for these patients. As a result, shared decision making around treatment options is vital so that patients are fully aware of the meaning of their diagnosis and their management options including active surveillance. Importantly, interventions to reduce unnecessary diagnoses of PMC are critically needed.

UR - http://www.scopus.com/inward/record.url?scp=85042882203&partnerID=8YFLogxK

U2 - 10.1186/s12885-018-4152-9

DO - 10.1186/s12885-018-4152-9

M3 - Article

VL - 18

JO - BMC Cancer

JF - BMC Cancer

SN - 1471-2407

IS - 1

M1 - 242

ER -