Active surveillance for thyroid Cancer: a qualitative study of barriers and facilitators to implementation.
Active surveillance for thyroid Cancer: a qualitative study of barriers and facilitators to implementation.
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DOI：
10.1186/s12885-021-08230-8
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发表时间：
2021-04-28
期刊：
影响因子：
3.8
通讯作者：
Pitt SC
中科院分区：
文献类型：
--
作者：
Jensen CB;Saucke MC;Pitt SC
2015年美国甲状腺协会指南支持将主动监测(AS)作为管理选定的低风险甲状腺癌的战略。检查医生对该选项的可接受性的态度的数据是有限的。这项研究旨在描述美国执业内分泌学家和外科医生所认为的实施AS的障碍和促进者。我们进行了24次半结构化访谈，探讨医生对小的、低风险的甲状腺癌患者的态度。我们使用演绎内容分析，以著名的指南实施模式为指导。分析表征了与AS实施相关的概念和主题，如医生、指南或外部因素。我们执行了成员检查以验证结果。AS最突出的障碍与医生因素有关，尽管也观察到指南特有的和外部障碍。医生对AS的态度构成了大多数与医生相关的障碍，同时对指南缺乏了解也进行了讨论。参与者对观察癌症导致的潜在负面后果的担忧是值得注意的，同样值得注意的是，他们对实施和提供监测缺乏信心。对患者期望的信念和对指南缺乏了解也被认为是提供监测的障碍。指南特有的外部障碍包括监测方案的模糊性、缺乏支持主动监测的数据以及社会对癌症的信念。积极监测的促进者包括患者避免手术的愿望和共同的决策。低风险甲状腺癌主动监测的障碍和促进者存在于多个层面。增加采用主动监测的战略应侧重于医生的态度、患者的期望、支持监测结果的数据，以及促进社会层面对监测的接受。
The 2015 American Thyroid Association guidelines supported active surveillance (AS) as a strategy for managing select low-risk thyroid cancers. Data examining physicians’ attitudes about the acceptability of this option are limited. This study aimed to characterize the barriers and facilitators to implementing AS as perceived by practicing endocrinologists and surgeons in the United States. We conducted 24 semi-structured interviews probing physicians’ attitudes toward AS for patients with small, low-risk thyroid cancer. We used deductive content analysis guided by a well-known model of guideline implementation. Analysis characterized concepts and themes related to AS implementation as physician, guideline, or external factors. We performed member checking to validate results. The most prominent barriers to AS were related to physician factors, although guideline-specific and external barriers were also observed. Physician attitudes towards AS comprised the majority of physician-related barriers, while lack of knowledge about the guideline was also discussed. Participants’ concerns about the potential negative outcomes resulting from observing a cancer were notable as were the lack of confidence in performing and offering surveillance. Beliefs about patient expectations and lack of knowledge about the guideline were also identified as barriers to offering surveillance. Guideline-specific and external barriers included the vagueness of surveillance protocols, lack of data supporting active surveillance, and societal beliefs about cancer. Facilitators of active surveillance included patients’ desire to avoid surgery and shared decision-making. Barriers and facilitators of active surveillance for low-risk thyroid cancers exist at multiple levels. Strategies to increase adoption of active surveillance should focus on physicians’ attitudes, patient expectations, data supporting surveillance outcomes, and promoting societal-level acceptance of surveillance.
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