BACKGROUND
Low-risk thyroid cancer is quite common and usually does not cause big problems for the patients. In the past, the usual treatment for all thyroid cancers was to remove the thyroid and sometimes use radioactive iodine treatment. But over time, it was noticed that people with this type of cancer rarely had serious problems. This raised a concern that treatments might be riskier than the cancer itself. So, the guidelines for treatment of low-risk thyroid cancer started to change. Now, there are many options, including just watching the cancer using ultrasound without doing anything else. Another change over the years has been more involvement of the patient in discussions to determine the best treatment option. This is often termed “shared-decision making”.

We do not have many studies yet where patients were randomly chosen to get different treatments in order to determine the best treatment. Thus doctors are less certain as to what is the “best treatment” to recommend to a patient. This uncertainty can confuse patients and make them unhappy when they try to decide about their treatment. More importantly, not much has been studied about what patients think of these treatments and how they affect the quality of their lives. In these cases, shared-decision making is important for both patients and doctors to decide on the treatments together. To make this happen in the best possible way, we need to understand the factors that influence the decisions for both the patients and doctors.

This study wanted to find out which are the most important of these factors and suggest ideas for better decision making tools for patients with low-risk thyroid cancer.

THE FULL ARTICLE TITLE
Yang W et al 2023 Challenges of shared decision-making by clinicians and patients with low-risk differentiated thyroid cancer: A systematic review and meta-ethnography. JAMA Otolaryngol Head Neck Surg 149:452–459. PMID: 36951823.

SUMMARY OF THE STUDY
The authors of this study looked at many different research papers using a special reporting guideline called PRISMA. They looked for the papers in several large databases in November 2021 and again in May 2022. They only chose the papers that talked about what adult patients and their doctors think when deciding about treating low risk thyroid cancer. They did not use the papers that only had numbers. They also didn’t use papers that were not in English or ones that were reviews of other papers.

The authors used special tools to check how good each study was and 2 people worked closely together for the review process to make sure the study quality was good. They used a special method to understand what the studies were saying. This method helped them to put similar things together and find the main ideas that came up in a lot of studies.

They found 1081 articles in total. After taking away the same ones and the ones that weren’t about the thoughts or beliefs of patients or doctors about thyroid cancer, they had 12 good articles left. These studies were all focused on how doctors and patients made treatment decisions based on information from interviews or focus groups. They found out important things: 1-many patients want aggressive treatment and think it is urgent while others worry about the side effects of treatment and delay or prefer nonsurgical treatment. 2- Doctors may also feel anxious about the cancer getting worse and might recommend more aggressive treatments despite the awareness that this type of cancer rarely spreads while carefully monitored. 3- Doctors often gave only one treatment option based on what they thought the patient wanted and they did not correctly understand patient concerns and preferences. 4- patients really liked having a good relationship with their doctors but doctors didn’t always know how much this mattered to patients.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
In conclusion, patients have 2 distinct preferences, some favor aggressive treatment, while others prioritize how they would feel after treatment and prefer a conservative approach. Doctors’ own anxiety influence treatment decisions and they sometimes find it hard to understand what patients want. This study makes it clear that doctors and patients need to talk more openly about treatment choices. This would help to avoid unnecessary treatment, reduce anxiety, and risk of side effects. When doctors understand and consider patient concerns, they can recommend better plans. When patients are actively involved in their health decisions, they feel more comfortable and follow through with their treatment plans.

— Ebru Sulanc, MD

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