Development of a Decision Aid for Patients With Low-Risk Thyroid Cancer: A Mixed-Methods Analysis of Feedback From Both Patient and Clinicians.

IF 2.5 3区 医学 Q2 SURGERY
World Journal of Surgery Pub Date : 2025-10-01 Epub Date: 2025-08-30 DOI:10.1002/wjs.70064
Christine J O'Neill, Ahmad Alam, Michelle Chapman, Melissa Carlson, Suzanne Clark-Pitrolo, Elizabeth A Fradgley, Christine Paul, Nicholas Zdenkowski, Christopher W Rowe
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引用次数: 0

Abstract

Introduction: Guideline-driven de-escalation of the extent of surgery for low-risk thyroid cancer has made treatment decisions more complex. Shared decision-making (SDM) is more involved than informed consent, improves patient satisfaction, and is considered standard of care. Patient decision aids (DA) can facilitate SDM but appropriate resources are lacking.

Methods: DA development occurred in 3 main phases. First, a prototype DA was developed and refined by a working group (clinicians, behavioral scientists, nurses, and trained consumer). Nationwide clinician consultation sessions obtained mixed-methods feedback leading to a hybrid paper-web DA ready for patient testing. Second, the paper DA was used within clinically appropriate consultations (Bethesda 3-6 thyroid nodules) and patient feedback obtained with the Ottawa acceptability and decisional conflict scales. Three cycles of iterative changes were made to the DA. Patient focus groups led to further refinements. Third, 40 clinicians were invited to review DA materials, providing mixed-methods feedback.

Results: Initial clinician consultation sessions (n = 113) revealed that surgeons used information resources more frequently in, and were more satisfied with, their current patient discussions around thyroid cancer management compared with endocrinologists (88% vs. 32% and 95% vs. 46% respectively, p < 0.01 for both). 95% of clinicians were open to using the DA, but concerns regarding availability, appropriateness, flexibility, credibility and potential to lengthen consultations, were raised. Patients reported that the DA was useful (97% paper, 100% web) and sufficient (85% paper, 100% web). Decisional conflict was low (17 paper vs. 12 web). Qualitative feedback led to changes to improve visual appeal, readability and minimize emotive responses. Clinician review of DA (60% response) reported no bias (73% paper, 79% web) and 86% felt the DA would be easily incorporated into practice.

Conclusion: We present a hybrid paper and web-DA ready for wider testing in patients with low-risk thyroid cancer to complement SDM regarding the extent of surgery.

低风险甲状腺癌患者决策辅助的发展:对患者和临床医生反馈的混合方法分析。
导言:低风险甲状腺癌手术范围的降低使得治疗决策更加复杂。共同决策(SDM)比知情同意更重要,提高了患者满意度,被认为是标准的护理。患者决策辅助(DA)可以促进SDM,但缺乏适当的资源。方法:DA的发展分为3个主要阶段。首先,一个工作小组(临床医生、行为科学家、护士和训练有素的消费者)开发并完善了数据处理的原型。全国范围内的临床医生咨询会议获得了混合方法的反馈,从而形成了一种混合的纸网DA,为患者测试做好了准备。其次,论文DA用于临床适当的会诊(Bethesda 3-6甲状腺结节)和患者反馈,通过渥太华可接受性和决策冲突量表获得。对DA进行了三个周期的迭代更改。患者焦点小组导致了进一步的改进。第三,邀请40名临床医生审查DA材料,提供混合方法反馈。结果:最初的临床医生咨询会议(n = 113)显示,与内分泌学家相比,外科医生更频繁地使用信息资源,并且对他们目前关于甲状腺癌管理的患者讨论更满意(分别为88%对32%和95%对46%)。结论:我们提出了一份混合论文和web-DA,准备在低风险甲状腺癌患者中进行更广泛的测试,以补充关于手术程度的SDM。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
World Journal of Surgery
World Journal of Surgery 医学-外科
CiteScore
5.10
自引率
3.80%
发文量
460
审稿时长
3 months
期刊介绍: World Journal of Surgery is the official publication of the International Society of Surgery/Societe Internationale de Chirurgie (iss-sic.com). Under the editorship of Dr. Julie Ann Sosa, World Journal of Surgery provides an in-depth, international forum for the most authoritative information on major clinical problems in the fields of clinical and experimental surgery, surgical education, and socioeconomic aspects of surgical care. Contributions are reviewed and selected by a group of distinguished surgeons from across the world who make up the Editorial Board.
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