Adoption of Active Surveillance for Very Low-Risk Differentiated Thyroid Cancer in the United States: A National Survey
Adoption of Active Surveillance for Very Low-Risk Differentiated Thyroid Cancer in the United States: A National Survey
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DOI：
10.1210/clinem/dgaa942
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发表时间：
2021-04-01
影响因子：
5.8
通讯作者：
Roman, Benjamin R.
中科院分区：
文献类型：
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作者：
Pitt, Susan C.;Yang, Nan;Roman, Benjamin R.
背景：在美国，通过连续超声对甲状腺癌进行主动监测 (AS) 是一种较新的管理选择。目的：这项工作旨在了解与采用 AS 相关的因素。方法：我们在美国医学会主文件中对内分泌科医生和外科医生进行了调查。为了估计采用情况，受访者建议对 2 个适合 AS 的假设病例进行治疗。建立指南实施指导问卷开发的模型。结果指标包括采用 AS（未采用者与采用者，分别不推荐或至少推荐一次 AS；以及部分采用者与完全采用者，分别在一种或两种情况下推荐 AS）。 结果：464 名受访者（33.3% 的答复）在人口统计学上代表了治疗甲状腺癌的专业。非采用者 (45.7%) 显着 (P < .001) 低于采用者在学术环境中实践、每年接诊超过 25 名甲状腺癌患者、了解 AS、使用适用的指南 (P = .04)、知道如何确定患者是否适合 AS、有资源执行 AS 或有动机使用 AS。未采用者也明显更有可能对 AS 感到焦虑或持保留态度，担心不良结果，或认为 AS 会给患者带来心理负担。在采用者中，部分采用者和完全采用者相似，只是部分采用者不太可能与患者讨论 AS (P = .03)，而更有可能感到焦虑 (P = .04)、持保留态度 (P = .03) 以及担心 AS 的心理负担 (P = .009)。很少有受访者 (3.2%) 相信患者了解 AS。结论：AS 的广泛采用需要提高患者和医生的认识、兴趣和结果评估。
Context: Active surveillance (AS) of thyroid cancer with serial ultrasounds is a newer management option in the United States.Objective: This work aimed to understand factors associated with the adoption of AS.Methods: We surveyed endocrinologists and surgeons in the American Medical Association Masterfile. To estimate adoption, respondents recommended treatment for 2 hypothetical cases appropriate for AS. Established models of guideline implementation guided questionnaire development. Outcome measures included adoption of AS (nonadopters vs adopters, who respectively did not recommend or recommended AS at least once; and partial vs full adopters, who respectively recommended AS for one or both cases).Results: The 464 respondents (33.3% response) demographically represented specialties that treat thyroid cancer. Nonadopters (45.7%) were significantly (P < .001) less likely than adopters to practice in academic settings, see more than 25 thyroid cancer patients/year, be aware of AS, use applicable guidelines (P = .04), know how to determine whether a patient is appropriate for AS, have resources to perform AS, or be motivated to use AS. Nonadopters were also significantly more likely to be anxious or have reservations about AS, be concerned about poor outcomes, or believe AS places a psychological burden on patients. Among adopters, partial and full adopters were similar except partial adopters were less likely to discuss AS with patients (P = .03) and more likely to be anxious (P = .04), have reservations (P = .03), and have concerns about the psychological burden (P = .009) of AS. Few respondents (3.2%) believed patients were aware of AS.Conclusion: Widespread adoption of AS will require increased patient and physician awareness, interest, and evaluation of outcomes.