From Overdiagnosis to Overtreatment of Low-Risk Thyroid Cancer: A Thematic Analysis of Attitudes and Beliefs of Endocrinologists, Surgeons, and Patients
Introduction: The optimal management for patients with small, low-risk thyroid cancer is often debated. We aimed to characterize the attitudes and beliefs of providers and patients about management of small, low-risk thyroid cancer and how they relate to overtreatment. Methods: We conducted 34 semi-...
Gespeichert in:
| Veröffentlicht in: | Thyroid (New York, N.Y.) N.Y.), 2020-05, Vol.30 (5), p.696-703 |
|---|---|
| Hauptverfasser: | , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 703 |
|---|---|
| container_issue | 5 |
| container_start_page | 696 |
| container_title | Thyroid (New York, N.Y.) |
| container_volume | 30 |
| creator | Jensen, Catherine B Saucke, Megan C Francis, David O Voils, Corrine I Pitt, Susan C |
| description | Introduction:
The optimal management for patients with small, low-risk thyroid cancer is often debated. We aimed to characterize the attitudes and beliefs of providers and patients about management of small, low-risk thyroid cancer and how they relate to overtreatment.
Methods:
We conducted 34 semi-structured interviews with surgeons (
n
= 12), endocrinologists (
n
= 12), and patients with |
| doi_str_mv | 10.1089/thy.2019.0587 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7232663</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2334702602</sourcerecordid><originalsourceid>FETCH-LOGICAL-c497t-e205c02984323808884879085a471684928f960ff27b602db9c421822a3d78553</originalsourceid><addsrcrecordid>eNqFkcFvFCEYxSfGxtbq0avh6MFZP2AYwIPJumnVZJMarWfCMswuOgMVmJr9T_xzZbq1aU898eV9v7wHvKp6hWGBQch3ebdfEMByAUzwJ9UJZozXEjh_WmZgUHPC2uPqeUo_AXArOH1WHVMsMYAkJ9Xf8xhGdHFtY-f01ofkEsrhRsjR6jxan1Ho0Tr8qb-59Atd7vYxuA6ttDc2vkfLothRZ2fQ0uthPxsUfpmzy1NnE9K-Qx_t4Gx_szjzXTDR-TCErUs5vUXfp7i1wZdpRr8Wq5KZXlRHvR6SfXl7nlY_zs8uV5_r9cWnL6vlujaN5Lm2BJgBIkVDCRUghGgElyCYbnh5bSOJ6GULfU_4pgXSbaRpCBaEaNpxwRg9rT4cfK-mzWg7U7KjHtRVdKOOexW0Uw833u3UNlwrTihpW1oM3twaxPB7simr0SVjh0F7G6akCKUNB1LCC1ofUBNDStH2dzEY1NymKm2quU01t1n41_fvdkf_r68A9ADMsva-_PKmFPeI7T81Pq3j</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2334702602</pqid></control><display><type>article</type><title>From Overdiagnosis to Overtreatment of Low-Risk Thyroid Cancer: A Thematic Analysis of Attitudes and Beliefs of Endocrinologists, Surgeons, and Patients</title><source>Alma/SFX Local Collection</source><creator>Jensen, Catherine B ; Saucke, Megan C ; Francis, David O ; Voils, Corrine I ; Pitt, Susan C</creator><creatorcontrib>Jensen, Catherine B ; Saucke, Megan C ; Francis, David O ; Voils, Corrine I ; Pitt, Susan C</creatorcontrib><description>Introduction:
The optimal management for patients with small, low-risk thyroid cancer is often debated. We aimed to characterize the attitudes and beliefs of providers and patients about management of small, low-risk thyroid cancer and how they relate to overtreatment.
Methods:
We conducted 34 semi-structured interviews with surgeons (
n
= 12), endocrinologists (
n
= 12), and patients with <1.5 cm papillary thyroid cancer (
n
= 10). Interviews probed about diagnosis and treatment decision-making, including nonoperative options. We used thematic analysis to identify themes related to overtreatment and created concept diagrams to map observed relationships between themes.
Results:
When providers discussed management of small, low-risk thyroid cancer, most felt that overtreatment was a problem, and some brought it up without prompting. Providers often believed that overtreatment results from overdiagnosis and relayed how the process commonly starts with incidental discovery of a thyroid nodule on imaging. Providers viewed biopsy of the nodule as a reflexive or habitual action. They ascribed inappropriate biopsy to lack of adherence to or knowledge of guidelines, radiologist recommendations, and the desire of patients and physicians to minimize diagnostic uncertainty. Providers described subsequent cancer diagnosis as an event that “opens Pandora's box” and often provokes a strong instinctive, culturally rooted need to proceed with surgery—specifically total thyroidectomy. Consequently, most providers felt that it is easier to prevent overdiagnosis than overtreatment and recommended strategies such as improving guideline adherence, resetting patients' expectations, and engaging the media. In contrast, patients did not bring up or openly discuss overtreatment or overdiagnosis. Some patients described the seemingly automatic process from an incidental finding to surgery. Their statements confirmed that the “need to know” was a major motivation for biopsying their nodule. Patients felt that once they had a cancer diagnosis, surgery was a foregone conclusion. Patients admitted their knowledge about thyroid nodules and cancer was low, leaving room for education about the need for biopsy and less extensive treatment options.
Conclusions:
Surgeons' and endocrinologists' attitudes and beliefs about overtreatment focus on the automaticity of overdiagnosis. Both patients and providers are cognizant of the cascade of clinical events that propel patients from incidental discovery of a thyroid nodule to surgery.</description><identifier>ISSN: 1050-7256</identifier><identifier>EISSN: 1557-9077</identifier><identifier>DOI: 10.1089/thy.2019.0587</identifier><identifier>PMID: 31910092</identifier><language>eng</language><publisher>United States: Mary Ann Liebert, Inc., publishers</publisher><subject>Thyroid Cancer and Nodules</subject><ispartof>Thyroid (New York, N.Y.), 2020-05, Vol.30 (5), p.696-703</ispartof><rights>2020, Mary Ann Liebert, Inc., publishers</rights><rights>Copyright 2020, Mary Ann Liebert, Inc., publishers 2020 Mary Ann Liebert, Inc., publishers</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c497t-e205c02984323808884879085a471684928f960ff27b602db9c421822a3d78553</citedby><cites>FETCH-LOGICAL-c497t-e205c02984323808884879085a471684928f960ff27b602db9c421822a3d78553</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31910092$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jensen, Catherine B</creatorcontrib><creatorcontrib>Saucke, Megan C</creatorcontrib><creatorcontrib>Francis, David O</creatorcontrib><creatorcontrib>Voils, Corrine I</creatorcontrib><creatorcontrib>Pitt, Susan C</creatorcontrib><title>From Overdiagnosis to Overtreatment of Low-Risk Thyroid Cancer: A Thematic Analysis of Attitudes and Beliefs of Endocrinologists, Surgeons, and Patients</title><title>Thyroid (New York, N.Y.)</title><addtitle>Thyroid</addtitle><description>Introduction:
The optimal management for patients with small, low-risk thyroid cancer is often debated. We aimed to characterize the attitudes and beliefs of providers and patients about management of small, low-risk thyroid cancer and how they relate to overtreatment.
Methods:
We conducted 34 semi-structured interviews with surgeons (
n
= 12), endocrinologists (
n
= 12), and patients with <1.5 cm papillary thyroid cancer (
n
= 10). Interviews probed about diagnosis and treatment decision-making, including nonoperative options. We used thematic analysis to identify themes related to overtreatment and created concept diagrams to map observed relationships between themes.
Results:
When providers discussed management of small, low-risk thyroid cancer, most felt that overtreatment was a problem, and some brought it up without prompting. Providers often believed that overtreatment results from overdiagnosis and relayed how the process commonly starts with incidental discovery of a thyroid nodule on imaging. Providers viewed biopsy of the nodule as a reflexive or habitual action. They ascribed inappropriate biopsy to lack of adherence to or knowledge of guidelines, radiologist recommendations, and the desire of patients and physicians to minimize diagnostic uncertainty. Providers described subsequent cancer diagnosis as an event that “opens Pandora's box” and often provokes a strong instinctive, culturally rooted need to proceed with surgery—specifically total thyroidectomy. Consequently, most providers felt that it is easier to prevent overdiagnosis than overtreatment and recommended strategies such as improving guideline adherence, resetting patients' expectations, and engaging the media. In contrast, patients did not bring up or openly discuss overtreatment or overdiagnosis. Some patients described the seemingly automatic process from an incidental finding to surgery. Their statements confirmed that the “need to know” was a major motivation for biopsying their nodule. Patients felt that once they had a cancer diagnosis, surgery was a foregone conclusion. Patients admitted their knowledge about thyroid nodules and cancer was low, leaving room for education about the need for biopsy and less extensive treatment options.
Conclusions:
Surgeons' and endocrinologists' attitudes and beliefs about overtreatment focus on the automaticity of overdiagnosis. Both patients and providers are cognizant of the cascade of clinical events that propel patients from incidental discovery of a thyroid nodule to surgery.</description><subject>Thyroid Cancer and Nodules</subject><issn>1050-7256</issn><issn>1557-9077</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNqFkcFvFCEYxSfGxtbq0avh6MFZP2AYwIPJumnVZJMarWfCMswuOgMVmJr9T_xzZbq1aU898eV9v7wHvKp6hWGBQch3ebdfEMByAUzwJ9UJZozXEjh_WmZgUHPC2uPqeUo_AXArOH1WHVMsMYAkJ9Xf8xhGdHFtY-f01ofkEsrhRsjR6jxan1Ho0Tr8qb-59Atd7vYxuA6ttDc2vkfLothRZ2fQ0uthPxsUfpmzy1NnE9K-Qx_t4Gx_szjzXTDR-TCErUs5vUXfp7i1wZdpRr8Wq5KZXlRHvR6SfXl7nlY_zs8uV5_r9cWnL6vlujaN5Lm2BJgBIkVDCRUghGgElyCYbnh5bSOJ6GULfU_4pgXSbaRpCBaEaNpxwRg9rT4cfK-mzWg7U7KjHtRVdKOOexW0Uw833u3UNlwrTihpW1oM3twaxPB7simr0SVjh0F7G6akCKUNB1LCC1ofUBNDStH2dzEY1NymKm2quU01t1n41_fvdkf_r68A9ADMsva-_PKmFPeI7T81Pq3j</recordid><startdate>20200501</startdate><enddate>20200501</enddate><creator>Jensen, Catherine B</creator><creator>Saucke, Megan C</creator><creator>Francis, David O</creator><creator>Voils, Corrine I</creator><creator>Pitt, Susan C</creator><general>Mary Ann Liebert, Inc., publishers</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20200501</creationdate><title>From Overdiagnosis to Overtreatment of Low-Risk Thyroid Cancer: A Thematic Analysis of Attitudes and Beliefs of Endocrinologists, Surgeons, and Patients</title><author>Jensen, Catherine B ; Saucke, Megan C ; Francis, David O ; Voils, Corrine I ; Pitt, Susan C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c497t-e205c02984323808884879085a471684928f960ff27b602db9c421822a3d78553</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Thyroid Cancer and Nodules</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jensen, Catherine B</creatorcontrib><creatorcontrib>Saucke, Megan C</creatorcontrib><creatorcontrib>Francis, David O</creatorcontrib><creatorcontrib>Voils, Corrine I</creatorcontrib><creatorcontrib>Pitt, Susan C</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Thyroid (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jensen, Catherine B</au><au>Saucke, Megan C</au><au>Francis, David O</au><au>Voils, Corrine I</au><au>Pitt, Susan C</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>From Overdiagnosis to Overtreatment of Low-Risk Thyroid Cancer: A Thematic Analysis of Attitudes and Beliefs of Endocrinologists, Surgeons, and Patients</atitle><jtitle>Thyroid (New York, N.Y.)</jtitle><addtitle>Thyroid</addtitle><date>2020-05-01</date><risdate>2020</risdate><volume>30</volume><issue>5</issue><spage>696</spage><epage>703</epage><pages>696-703</pages><issn>1050-7256</issn><eissn>1557-9077</eissn><abstract>Introduction:
The optimal management for patients with small, low-risk thyroid cancer is often debated. We aimed to characterize the attitudes and beliefs of providers and patients about management of small, low-risk thyroid cancer and how they relate to overtreatment.
Methods:
We conducted 34 semi-structured interviews with surgeons (
n
= 12), endocrinologists (
n
= 12), and patients with <1.5 cm papillary thyroid cancer (
n
= 10). Interviews probed about diagnosis and treatment decision-making, including nonoperative options. We used thematic analysis to identify themes related to overtreatment and created concept diagrams to map observed relationships between themes.
Results:
When providers discussed management of small, low-risk thyroid cancer, most felt that overtreatment was a problem, and some brought it up without prompting. Providers often believed that overtreatment results from overdiagnosis and relayed how the process commonly starts with incidental discovery of a thyroid nodule on imaging. Providers viewed biopsy of the nodule as a reflexive or habitual action. They ascribed inappropriate biopsy to lack of adherence to or knowledge of guidelines, radiologist recommendations, and the desire of patients and physicians to minimize diagnostic uncertainty. Providers described subsequent cancer diagnosis as an event that “opens Pandora's box” and often provokes a strong instinctive, culturally rooted need to proceed with surgery—specifically total thyroidectomy. Consequently, most providers felt that it is easier to prevent overdiagnosis than overtreatment and recommended strategies such as improving guideline adherence, resetting patients' expectations, and engaging the media. In contrast, patients did not bring up or openly discuss overtreatment or overdiagnosis. Some patients described the seemingly automatic process from an incidental finding to surgery. Their statements confirmed that the “need to know” was a major motivation for biopsying their nodule. Patients felt that once they had a cancer diagnosis, surgery was a foregone conclusion. Patients admitted their knowledge about thyroid nodules and cancer was low, leaving room for education about the need for biopsy and less extensive treatment options.
Conclusions:
Surgeons' and endocrinologists' attitudes and beliefs about overtreatment focus on the automaticity of overdiagnosis. Both patients and providers are cognizant of the cascade of clinical events that propel patients from incidental discovery of a thyroid nodule to surgery.</abstract><cop>United States</cop><pub>Mary Ann Liebert, Inc., publishers</pub><pmid>31910092</pmid><doi>10.1089/thy.2019.0587</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1050-7256 |
| ispartof | Thyroid (New York, N.Y.), 2020-05, Vol.30 (5), p.696-703 |
| issn | 1050-7256 1557-9077 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7232663 |
| source | Alma/SFX Local Collection |
| subjects | Thyroid Cancer and Nodules |
| title | From Overdiagnosis to Overtreatment of Low-Risk Thyroid Cancer: A Thematic Analysis of Attitudes and Beliefs of Endocrinologists, Surgeons, and Patients |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-12T22%3A18%3A23IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=From%20Overdiagnosis%20to%20Overtreatment%20of%20Low-Risk%20Thyroid%20Cancer:%20A%20Thematic%20Analysis%20of%20Attitudes%20and%20Beliefs%20of%20Endocrinologists,%20Surgeons,%20and%20Patients&rft.jtitle=Thyroid%20(New%20York,%20N.Y.)&rft.au=Jensen,%20Catherine%20B&rft.date=2020-05-01&rft.volume=30&rft.issue=5&rft.spage=696&rft.epage=703&rft.pages=696-703&rft.issn=1050-7256&rft.eissn=1557-9077&rft_id=info:doi/10.1089/thy.2019.0587&rft_dat=%3Cproquest_pubme%3E2334702602%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2334702602&rft_id=info:pmid/31910092&rfr_iscdi=true |