Patients' experiences of diagnosis and management of papillary thyroid microcarcinoma: a qualitative study.
Patients' experiences of diagnosis and management of papillary thyroid microcarcinoma: a qualitative study.
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DOI：
10.1186/s12885-018-4152-9
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发表时间：
2018-03-02
期刊：
影响因子：
3.8
通讯作者：
McCaffery K
中科院分区：
文献类型：
--
作者：
Nickel B;Brito JP;Moynihan R;Barratt A;Jordan S;McCaffery K
近年来，随着人们对潜在的过度诊断和过度治疗的认识不断提高，以及对非手术治疗选择（如积极监测）的指南建议，与低风险乳头状微小癌（PMC）相关的管理实践也在不断发展。本研究旨在深入了解患者在PMC诊断沟通、治疗偏好和决策方面的经验。对25名术前诊断为PMC的患者进行半结构化定性访谈，自诊断和治疗后< 1年。访谈于2015年9月至2016年7月进行，并进行了录音和逐字转录。采用框架分析法对数据进行分析。PMC患者的诊断和治疗经验差异很大。大多数患者无症状，他们的PMC最初是通过与甲状腺疾病或症状无关的原因要求的成像检查检测到的。临床医生通常将PMC描述为“小”或“生长缓慢”的癌症，几乎没有证据表明临床医生讨论过过度诊断或过度治疗的可能性。总体而言，手术是讨论并提供给患者的唯一选择。患者对治疗的偏好主要是基于消除癌症扩散的可能性（甲状腺切除术）或不想在余生中接受甲状腺替代药物（半甲状腺切除术）。许多患者报告了与他们的诊断和治疗相关的情绪和身体副作用，但患者普遍表示，如果主动监测提供给他们，他们不会感兴趣。有证据表明，许多PMC患者可能被过度诊断，管理指南建议对这些患者采取更保守的管理方案。因此，围绕治疗方案的共同决策至关重要，以便患者充分了解其诊断和管理方案的意义，包括积极监测。重要的是，迫切需要采取干预措施，减少不必要的PMC诊断。本文的在线版本（10.1186/s12885-018-4152-9）包含补充材料，可供授权用户使用。
In recent years management practices in relation to low-risk papillary microcarcinoma (PMC) have been evolving with increased awareness of the potential overdiagnosis and overtreatment of PMCs, and guidelines recommendations for non-surgical management options such as active surveillance. This study aimed to develop an in-depth understanding of patients’ experiences of the communication of their PMC diagnosis, their treatment preferences and decision making. Semi-structured qualitative interviews with 25 patients diagnosed pre-operatively with PMC < 1 year since their diagnosis and treatment. Interviews were conducted between September 2015 and July 2016 and were audio-recorded and transcribed verbatim. Framework analysis method was used to analyse the data. The diagnosis and treatment experience of PMC patients varied widely. The majority of patients were asymptomatic, and their PMC was initially detected via an imaging test requested for a reason unrelated to a thyroid disorder or symptom. Clinicians generally described PMC to patients as being a “small” or “slow-growing” cancer, and there was little evidence that clinicians had discussions about the possibility of overdiagnosis or overtreatment. Overall, surgery was the only option discussed and offered to patients. Patients preference for treatment was largely based on eliminating the possibility of the cancer spreading (thyroidectomy) or not wanting to be on thyroid replacement medication for the rest of their life (hemi-thyroidectomy). Many patients reported emotional and physical side-effects associated with their diagnosis and treatment, however patients generally indicated that active surveillance is not something they would have been interested in if it was offered to them. Evidence continues to emerge that many patients with PMCs may be overdiagnosed, and management guidelines are recommending more conservative management options for these patients. As a result, shared decision making around treatment options is vital so that patients are fully aware of the meaning of their diagnosis and their management options including active surveillance. Importantly, interventions to reduce unnecessary diagnoses of PMC are critically needed. The online version of this article (10.1186/s12885-018-4152-9) contains supplementary material, which is available to authorized users.
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