Barriers to the Use of Active Surveillance for Thyroid Cancer Results of a Physician Survey.
Barriers to the Use of Active Surveillance for Thyroid Cancer Results of a Physician Survey.
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DOI：
10.1097/sla.0000000000004417
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发表时间：
2022-07-01
影响因子：
9
通讯作者：
Haymart MR
中科院分区：
文献类型：
--
作者：
Hughes DT;Reyes-Gastelum D;Ward KC;Hamilton AS;Haymart MR
确定医生报告的甲状腺癌主动监测的使用情况和障碍。目前尚不清楚甲状腺癌的主动监测是否被广泛使用。在2018-2019年期间，对来自格鲁吉亚和洛杉矶县监测、流行病学和最终结果（SEER）登记处的甲状腺癌患者确定的外科医生和内分泌学家进行了调查。进行多变量加权逻辑回归分析，以确定医生接受和使用主动监测。在确定的654名合格医生中，有448名回答了调查（回答率为69%）。大多数人（76%）认为积极监测是一种适当的管理选择，但只有44%的人在实践中使用它。那些声称积极监测是适当的管理，但没有报告使用它的医生的特征包括更多的实践年数（参考组< 10年的实践）：10-19岁- OR 0.50 [CI 0.28-0.92]; 20-29岁- OR 0.31 [CI 0.15-0.62]; ≥30岁- OR 0.30 [CI 0.15-0.61]，患者数量11-30例/年（OR 0.39 [CI 0.21-0.70]）和>50例/年（OR 0.33 [CI 0.16-0.71]）与≤ 10例相比更高，在31-50例患者中无显著差异。医生报告了实施主动监测的多种障碍，包括患者不愿意（80.3%），失访（78.4%），更多患者担心（57.6%）和医疗事故诉讼（50.9%）。尽管大多数医生认为积极监测是适当的管理，但超过一半的人没有使用它。解决现有的障碍是提高使用率的关键。这项对为甲状腺癌患者提供护理的不同医生队列的调查表明，大多数提供者认为积极监测是某些低风险甲状腺癌患者的适当管理计划。然而，目前只有不到一半的供应商在实践中使用它。
To determine physician-reported use of and barriers to active surveillance for thyroid cancer. It isn’t clear if active surveillance for thyroid cancer is widely used. Surgeons and endocrinologists identified by thyroid cancer patients from the Surveillance, Epidemiology, and End Results (SEER) registries of Georgia and Los Angeles County were surveyed between 2018–2019. Multivariable weighted logistic regression analyses were conducted to determine physician acceptance and use of active surveillance. Of the 654 eligible physicians identified, 448 responded to the survey (69% response rate). The majority (76%) believed that active surveillance was an appropriate management option, but only 44% used it in their practice. Characteristics of physicians who stated that active surveillance was appropriate management, but did not report using it included more years in practice (reference group < 10 years in practice): 10–19 years - OR 0.50 [CI 0.28–0.92]; 20–29 years - OR 0.31 [CI 0.15–0.62]; ≥30 years - OR 0.30 [CI 0.15–0.61] and higher patient volume 11–30 patients per year (OR 0.39 [CI 0.21–0.70]) and >50 patients per year (OR 0.33 [CI 0.16–0.71]) compared to ≤ 10, with no significant difference in those seeing 31–50 patients. Physicians reported multiple barriers to implementing active surveillance including patient does not want (80.3%), loss to follow-up concern (78.4%), more patient worry (57.6%) and malpractice lawsuit concern (50.9%). Despite most physicians considering active surveillance to be appropriate management, more than half are not using it. Addressing existing barriers is key to improving uptake. This survey of a diverse cohort of physicians providing care to thyroid cancer patients demonstrates that most providers consider active surveillance to be an appropriate management plan for some patients with low-risk thyroid cancer. However, less than half of the providers are currently using it in their practice.