Brooke Nickel|Alexandra Barratt|Kevin McGeechan|Juan P. Brito|Ray Moynihan|Kirsten Howard|Kirsten McCaffery
Effect of a Change in Papillary Thyroid Cancer Terminology on Anxiety Levels and Treatment Preferences
University of Sydney|University of Sydney|University of Sydney|Mayo Clinic|University of Sydney|Bond University|University of Sydney|University of Sydney
h3importanceh3 given evidence overdiagnosis overtreatment small papillary thyroid cancers ptcs strategies needed promote consideration less invasive treatment options patients lowrisk ptc h3objectiveh3 determine association treatment preferences anxiety levels ptc terminology used describe condition h3design setting participantsh3 randomized crossover study involved community sample 550 australian men women 18 years older without history thyroid cancer march 16 2016 july 26 2016 participants accessed online study presented 3 hypothetical clinically realistic scenarios described ptc papillary thyroid cancer papillary lesion abnormal cells participants exposed 3 scenarios different terminologies participants randomized order first second third viewed terminologies data analysis conducted september 1 2016 may 15 2017 h3main outcomes measuresh3 treatment choice total thyroidectomy hemithyroidectomy active surveillance diagnosis anxiety treatment choice anxiety h3resultsh3 550 participants completed online study included analysis 279 507 female mean sd age 499 152 years higher proportion participants 108 196 chose total thyroidectomy papillary thyroid cancer used describe condition compared percentage participants chose total thyroidectomy papillary lesion 58 105 abnormal cells 60 109 terminology used first exposure papillary thyroid cancer terminology led 60 186 participants 323 choose surgery compared 46 191 participants 241 chose surgery exposed papillary lesion terminology first risk ratio rr 073 95 ci 053102 47 173 participants 272 exposed abnormal cells rr 082 95 ci 060114 terminology first first exposure participants viewed papillary thyroid cancer terminology reported significantly higher levels anxiety mean 78 11 points compared viewed papillary lesion mean 70 11 points mean difference 08 95 ci 13 03 abnormal cells mean 73 11 points mean difference 05 95 ci 10 001 overall interest active surveillance high higher levels anxiety reported chose surgery regardless terminology viewed first mean difference 15 95 ci 1019 h3conclusions relevanceh3 changing terminology small ptcs may one strategy reduce patients anxiety levels help consider less invasive management options curtail overdiagnosis overtreatment ptc strategies may include providing balanced information risks advantages alternative treatments h3trial registrationh3 anzctrorgau identifieractrn12616000271404