Impact of Emotions on Treatment Decisions About Low-Risk Thyroid Cancer

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PROJECT SUMMARY This K08 Career Development Award will address important gaps in the training of the applicant while simultaneously generating new knowledge about the role of emotions in cancer-related treatment decisions, a priority of the NCI. The incidence of thyroid cancer has increased at a rate faster than any other cancer, largely due to increased diagnosis of small, low-risk cancers  2 cm with a 10-year mortality close to zero. Overtreatment with total thyroidectomy occurs in the vast majority of these patients, resulting in significant harms, excess morbidity, and costs to both patients and society without a clear benefit. Currently, a lack of understanding about why patients prefer this extensive treatment limits our ability to reduce overtreatment of low-risk disease. The proposed research seeks to address this gap by investigating the impact of emotions on treatment decisions about small, low-risk thyroid cancer. The coordinated research and training proposal aims to: 1) characterize the emotional and cognitive communication between patients and surgeons during treatment decision making; 2) determine the relative value of treatment outcomes to patients undergoing total thyroidectomy at the time of the decision compared to one year postoperatively; and 3) test the extent to which increased emotionally supportive communication by surgeons is associated with decreased patient preference for total thyroidectomy. The central hypothesis is that is that emotions, such as fear and anxiety, influence patient-surgeon decision making about treatment for small, low-risk thyroid cancer leading to decisions that over treat. Completion of these aims will facilitate mentored-training in decision science that is vital to Dr. Pitt’s career goals. The proposed training will fill key educational and experiential gaps in the psychology of decision making and behavioral economics, which will be accompanied by methodologic training in qualitative research, preference measurement, choice experimentation, and factorial design. The applicant will draw upon the strengths of a diverse group of nationally and internationally recognized mentors with multidisciplinary expertise in experimental psychology, surgical decision-making, behavioral economics, and thyroid cancer treatment. This mentored training will support the applicant in becoming a successful surgeon-scientist with unique research skills. The results of the proposed research will provide new understanding about the specific role of emotions and emotionally supportive communication in treatment decisions in a low-risk cancer. At the end of the proposed training period, Dr. Pitt will have the results and experience necessary to obtain R01 funding to adapt and test behavioral and educational interventions that incorporate emotional support, thus reducing the harms and costs of overtreatment.