Anna Koot1
(1) Internal Medicine, Almere , The Netherlands.
Background:
Over the last decades optimal treatment for patients with differentiated thyroid cancer (DTC) is debated. Two important treatment decisions for patients with DTC who could benefit from more individualized approaches and shared decision making (SDM), are the extent of surgery decision in patients with low-risk DTC, and the decision to start or delay the treatment with Tyrosine Kinase Inhibitors (TKIs) in patients with advanced tumors. Our aim is to examine the effect of a patient decision aid (PtDA) on observed SDM for these approaches.
Module:
In this multicenter RCT (2020-2024), all participating physicians (n=26) received a SDM communication training, consisting of an e-learning, an in-hospital group training, and individual feedback on an audiorecorded conversation with a patient, lasting in total 5 hours. Subsequently, patients (n=86) with DTC were randomized to receive a PtDA or care as usual. The PtDA consisted of general information about DTC, oncological outcomes, several questions, and a values clarification exercise. The primary outcome was observed SDM process as rated with the OPTION5 from audio-recorded consultations. Secondary outcomes included decision related outcomes, knowledge on thyroid cancer, worries, trust and communication.
Results:
Mean OPTION5 scores were 52 (0-100, PtDA) and 54 (0-100, usual care). The PtDA did not improve observed SDM. The intervention neither affected decision related outcomes nor worries on cancer or trust in their physician. Subjective and objective knowledge did not improve by the PtDA. Beta testing (n=33) showed the PtDA was readable (n=30) and helpful for decision making (n=28). All patients recommended using the PtDA.
Conclusion:
The mean OPTION5 scores were high. When applied together with a communication training, a PtDA does not improve patient-reported SDM and other outcomes in patients with DTC. Nevertheless, for this preference sensitive decisions, physicians should consider the use of our PtDAs for ethical reasons and because of beneficial effects of PtDAs reported in the literature.